• The sound of the cough and the circumstances in which it occurs may be helpful in making
the diagnosis.
• A feeble non-explosive 'bovine' cough
... [Show More] with hoarseness may occur with respiratory
muscle weakness but is more usually associated with lung cancer invading the left
recurrent laryngeal nerve with resultant paralysis of the left vocal cord. A rare cause is
thoracic aortic aneurysm that also damages the left recurrent laryngeal nerve.
• Patients with severe airflow obstruction (asthma or COPD) often have prolonged wheezy
coughing, and sometimes the sustained increase in intrathoracic pressure is sufficient to
impair venous return to the heart, resulting in reduced cardiac output and cough syncope
or near-syncope.
• A paroxysmal dry cough in patients with asthma may follow a viral respiratory infection
and last several months.
• The cough of laryngeal inflammation, infection and tumour tends to be harsh, barking
or painful and may be associated with hoarseness and stridor.
• A moist cough usually indicates secretions in the upper and larger airways and occurs in
bronchial infection and bronchiectasis. A persistent moist 'smoker's' cough first thing in
the morning is typical of chronic bronchitis. Smokers often do not mention it because it is
so common they assume it is normal. Any change in the pattern of this cough may indicate
the development of lung cancer.
• A dry centrally painful and non-productive cough is a feature of tracheitis and
pneumonia.
• A chronic dry cough is common in interstitial disease, e.g. cryptogenic fibrosing
alveolitis.
SPUTUM PRODUCTION
• Expectorated respiratory secretions are known as sputum or phlegm and
need to be specifically asked about.
• Patients may find it difficult to discuss sputum production because of a
natural reluctance, and it may be regularly swallowed.
• Determine the amount and type of sputum.kThere are four main types of
sputum
Amount
• Ask how many teaspoons of sputum are coughed up each day. Statements
by patients that they cough up small (a teaspoonful) or large (a teacupful)
amounts of sputum are usually helpful.
• Regular coughing up of large volumes of purulent sputum influenced by
posture is characteristic of bronchiectasis.
• The sudden production of large amounts of purulent sputum on a single
occasion suggests the rupture of a lung abscess or empyema into the
bronchial tree.
• Large volumes of watery sputum with a pink tinge in an acutely breathless
patient suggests pulmonary oedema, whereas large volumes of watery
sputum for weeks (bronchorrhoea) is a symptom of alveolar cell cancer. [Show Less]