Evaluating Cough and Congestion

Initial Assessment

The American Thoracic Society recommends beginning with a focused medical history and physical examination to determine if the cough represents a life-threatening condition versus a common self-limited illness, while specifically identifying medication use, smoking status, and duration of symptoms to guide the diagnostic approach 1, 2, 3
For patients with acute cough, the American College of Chest Physicians suggests first ruling out serious illness such as pneumonia or pulmonary embolism versus typical viral upper respiratory infection 2, 3

The American Academy of Family Physicians recommends asking about ACE inhibitor use, as this is a common and reversible cause that should be addressed immediately by switching to another drug class 1, 2
Patients with subacute cough should be considered for post-infectious causes, including pertussis if cough persists >2 weeks with paroxysms, post-tussive vomiting, or inspiratory whooping 4

The American Heart Association suggests inquiring about β-adrenergic blocking medications that may exacerbate asthma 1, 2
Evaluate for any other drugs that could induce cough 2, 3

The American College of Physicians recommends measuring respiratory rate, heart rate, oxygen saturation, and blood pressure 5
Respiratory rate >35 breaths/min is a contraindication for swallowing evaluation and suggests severe respiratory compromise 8

The American Thoracic Society suggests a chest radiograph to rule out pneumonia, malignancy, structural abnormalities, or infiltrates 1, 2, 6, 7
Spirometry with bronchodilator testing should be considered to assess for asthma or obstructive lung disease 5

Peritoneal dialysis patients should be evaluated for GERD, ACE inhibitors, pulmonary edema, asthma exacerbated by β-blockers, and infection 1
Patients with lung cancer risk should obtain a chest radiograph if risk factors are present or known cancer elsewhere that could metastasize to lungs 6, 7