acute cough in the adult

introduction

acute onset of coughing is one of the commonest causes of presentations to a doctor
in the non-asthmatic adult, it is most commonly due to acute bronchitis, influenza or coryza but there is a wide range of differentials

ensure patients with potentially highly infectious conditions such as measles, SARS, etc are isolated and respiratory precautions are put in place ASAP
conjunctivitis, fever, hacking cough then a maculopapular rash should suggest measles
recent overseas travel, fever, cough may suggest influenza or SARS, etc

most infective causes including TB can cause haemoptysis and 60% of cases of haemoptysis are infective
minimal coryza, mild fevers, mild headache, myalgias
- acute bronchitis - starts as dry cough becomes very prominent, keeping awake at night and then productive cough
marked coryzal prodrome
- coryza +/- secondary sinusitis and post-nasal drip
- pertussis (whooping cough)
conjunctivitis suggests:
- measles
- adenovirus bronchitis / conjunctivitis
  - may also have diarrhoea, prolonged fevers, raised CRP
- secondary bacterial conjunctivitis from sneezing pushing nasal secretions up nasolacrimal duct, or nasal secretions transmitted to eye by hand, etc.
- Kawasaki disease
severe headaches and myalgias with minimal coryza
- influenza / coronaviridae / corona viruses (CoV) / Covid-19 / SARS virus / MERS / malaria
chest pain or hypoxia
- pneumonia / community acquired pneumonia (CAP) in adults / legionella
- influenza / coronaviridae / corona viruses (CoV) / Covid-19 / SARS virus / MERS
- bronchitis is patients with limited respiratory reserve eg. chronic obstructive pulmonary disease (COPD)
with stridor
- epiglottitis
- croup
with red currant jelly sputum
- Klebsiella
with rash
- measles
- varicella
- kawasaki

asthma
allergic reactions
irritant bronchitis
psychogenic
pulmonary embolism (PE)
acute pulmonary oedema (APO)
neoplastic
- lung cancer
aspiration
inhaled foreign body
drug reactions
- ACE inhibitors
with haemoptysis
- pseudohemoptysis
  - blood coming from the upper airways eg. posterior epistaxis, sinusitis,
- pulmonary embolism (PE)
- neoplastic
- cystic fibrosis
- congestive cardiac failure
- arteriotracheobronchial fistula
- pulmonary angiodysplasia
- pulmonary hypertension
- bronchiectasis
- systemic lupus erythematosus (SLE)
- Goodpastures syndrome
- Wegener's granulomatosis *Behcet disease**