Cough is a common symptom that ranges in significance from trivial to ominous. Typically, cough is a reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi. These stimuli include mucus, pus, blood, as well as external agents such as allergens, dust, foreign bodies, or even extremely hot or cold air. Other causes include inflammation of the respiratory mucosa, pneumonia, pulmonary edema, and compression of the bronchi or bronchioles from a tumor or enlarged peribronchial lymph nodes. Cough may also be cardiovascular in origin.
For complaints of cough, pursue a thorough assessment. Establish the duration. Is the cough acute, lasting less than 3 weeks; subacute, lasting 3 to 8 weeks; or chronic, more than 8 weeks?
Ask whether the cough is dry or produces sputum, or phlegm.
Ask the patient to describe the volume of any sputum and its color, odor, and consistency.
To help patients quantify volume, try a multiple-choice question. "How much do you think you cough up in 24 hours: a teaspoon, tablespoon, quarter cup, half cup, cupful?" If possible, ask the patient to cough into a tissue; inspect the phlegm, and note its characteristics. The symptoms associated with a cough often lead to its cause.
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