Evaluation of Cough in Adults and Children

Key Symptoms to Inquire About

The American Thoracic Society recommends assessing the duration and progression of the cough, as well as the character of the cough, including whether it is paroxysmal, dry, or productive, in patients with a 2-week history of cough 1, 2
The presence of sputum production, including amount, color, and consistency, should be evaluated, as it can help determine the underlying cause of the cough 2, 3
Diurnal variation of the cough, including whether it is worse at night, morning, or after meals, should be assessed, as it can provide clues to the underlying cause 2
The presence of a whooping sound during inspiration following coughing episodes is highly specific for pertussis and should be evaluated in patients with a 2-week history of cough 4

Post-tussive vomiting, which is highly specific for pertussis, should be assessed in patients with a 2-week history of cough, particularly in adults and children 1, 4
Shortness of breath, either at rest or with exertion, should be evaluated, as it can be a symptom of underlying respiratory disease 1, 5
Wheezing or chest tightness should be assessed, as it can be a symptom of asthma or other respiratory conditions 2, 3

The presence or absence of fever should be evaluated, as the absence of fever with paroxysmal cough suggests pertussis 4
Weight loss, which can be a symptom of tuberculosis or malignancy, should be assessed in patients with a 2-week history of cough 7, 8
Night sweats, which can be a symptom of tuberculosis, should be evaluated in patients with a 2-week history of cough 5, 7

Environmental triggers, such as cold air, exercise, pollutants, and allergens, should be assessed, as they can exacerbate the cough 2, 9
The response to previous treatments, including antibiotics, inhalers, and antihistamines, should be evaluated, as it can provide clues to the underlying cause of the cough 3

Hemoptysis, which is coughing up blood, is a red flag symptom that requires immediate evaluation, as it can be a symptom of underlying lung disease or malignancy 8
Hoarseness persisting with cough is a red flag symptom that requires evaluation, as it can be a symptom of underlying lung disease or malignancy 8
Recurrent pneumonia is a red flag symptom that requires evaluation, as it can be a symptom of underlying lung disease or immunodeficiency 8
Digital clubbing, which suggests chronic lung disease, should be assessed in patients with a 2-week history of cough 6, 9
Dysphagia, which is difficulty swallowing, is a red flag symptom that requires evaluation, as it can be a symptom of underlying esophageal disease or malignancy 8

In adults with a 2-week cough, specifically assess for paroxysmal cough, post-tussive vomiting, inspiratory whooping, and absence of fever, as these are key diagnostic features of pertussis 4
In endemic areas or high-risk populations, tuberculosis should be considered regardless of cough duration, and weight loss, night sweats, and hemoptysis should be assessed 7, 10
In children, paroxysmal cough, post-tussive vomiting, and whooping are particularly important to assess, as they can be symptoms of pertussis or other respiratory infections 9, 11