Merck Manual

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Some Causes and Features of Cough

Some Causes and Features of Cough

Cause

Common Features*

Tests

Acute (lasting less than 3 weeks)

Wheezing, shortness of breath, and breathing through pursed lips

Cough often produces sputum

In people who already have COPD

Usually only a doctor's examination

A foreign object†

A cough that begins suddenly typically in people who have a disorder that interferes with communication, swallowing, or both, or in children

No symptoms of an upper respiratory infection

In people who otherwise are feeling well

A chest x-ray

Shortness of breath that worsens while lying flat or that appears 1–2 hours after falling asleep

Usually sounds suggesting fluid in the lungs, heard through a stethoscope

Usually swelling (edema) in the legs

A chest x-ray

Sometimes a blood test to measure a substance called brain natriuretic peptide (BNP) that is produced when the heart is strained

Sometimes echocardiography

Fever, a feeling of illness, a cough that produces sputum (productive cough), and shortness of breath

Sudden onset of sharp chest pain that worsens when taking deep breaths

Certain abnormal breath sounds, heard through a stethoscope

A chest x-ray

Postnasal drip (due to an allergy, a virus, or bacteria)

Headache, sore throat, and a congested nose with pale, swollen mucosa

Nausea

Sometimes a drip visible at the back of the throat

Frequent clearing of the throat

Usually only a doctor's examination

Sometimes use of antihistamines and decongestant drugs to see whether symptoms go away

Pulmonary embolism (sudden blockage of an artery in a lung, usually by a blood clot)

Sudden appearance of sharp chest pain that usually worsens when inhaling

Shortness of breath

A rapid heart rate and a rapid breathing rate

Often risk factors for pulmonary embolism, such as cancer, immobility (as results from being bedbound), blood clots in the legs, pregnancy, use of birth control pills (oral contraceptives) or other drugs that contain estrogen, recent surgery or hospitalization, or a family history of the disorder

Specialized lung imaging tests, such as CT angiography, ventilation-perfusion (V/Q) scanning, or pulmonary arteriography

Upper respiratory infections, including acute bronchitis

A runny, congested nose with red mucosa (the tissues that line the nose)

Sore throat and a feeling of illness (malaise)

Usually only a doctor's examination

Chronic (lasting 3 weeks or longer)

Airway irritation that remains after a respiratory tract infection resolves

A dry, nonproductive cough that occurs immediately after a respiratory tract infection

No congested nose or sore throat

Sometimes only a doctor's examination, sometimes a chest x-ray

Angiotensin-converting enzyme (ACE) inhibitors

A dry, persistent cough

Use of an ACE inhibitor (cough may develop within days or months after starting the drug)

Stopping the ACE inhibitor to see whether symptoms go away

Aspiration

A wet-sounding cough after eating or drinking, visible difficulty swallowing, or both

In people who have had a stroke or another disorder that causes difficulty communicating (such as dementia), particularly among those who have a chronic cough

A chest x-ray

Sometimes x-ray tests of swallowing (modified barium pharyngography)

Asthma (cough-variant)

A cough that seems to occur after various triggers, such as exposure to pollen or another allergen, cold, or exercise

Possibly wheezing and shortness of breath

Pulmonary function testing

Sometimes use of bronchodilators (drugs that widen airways), such as albuterol, to see whether symptoms go away

Chronic bronchitis (in smokers)

A productive cough on most days of the month for 3 months of the year for 2 successive years

Frequent clearing of the throat and shortness of breath

No congested nose or sore throat

Tests to evaluate how well the lungs are functioning (pulmonary function tests)

Burning pain in the chest (heartburn) or abdomen that tends to worsen after eating certain foods, while exercising, or while lying flat

A sour taste, particularly after awakening

Hoarseness

Wheezing

A cough that occurs in the middle of the night or early morning

Sometimes no symptoms other than cough

Sometimes only a doctor's examination

Sometimes use of drugs that suppress acid, such as a histamine-2 (H2) blocker or proton pump inhibitor, to see whether symptoms go away

Sometimes insertion of a flexible viewing tube into the esophagus and stomach (endoscopy)

Sometimes placement of a sensor in the esophagus to monitor acidity (pH) for 24 hours

Interstitial lung disease

Shortness of breath of gradual onset

Dry cough

Previous exposure to certain drugs an occupation

Sometimes a family history of the disorder

Chest x-ray

CT of the chest

A lung tumor

A cough that sometimes produces blood

A change in a chronic cough

Weight loss, fever, and night sweats

Enlarged, firm, painless lymph nodes in the neck

A chest x-ray

Often CT of the chest

Often bronchoscopy

Postnasal drip

Headache, sore throat, and a congested nose with pale, swollen mucosa

Sometimes a drip visible at the back of the throat

Sometimes only a doctor's examination

Sometimes use of antihistamines and decongestants to see whether symptoms go away

Sometimes allergy testing

Tuberculosis or fungal infections†

A cough that sometimes produces blood

Weight loss, fever, and night sweats

Exposure to someone with tuberculosis

Residence in or travel to an area where tuberculosis or fungal lung infections are common

Presence of HIV infection or risk factors for HIV infection

A chest x-ray

Skin testing and, if positive, examination and culture of sputum

Sometimes CT of the chest

* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

† These causes are rare.

CT = computed tomography.