Red Flag Symptoms - Persistent cough

Asthma, malignancy and cystic fibrosis are all associated with this symptom, says Dr Barney Tinsley.

Bronchiectasis is possible in those presenting with persistent cough (Photograph: SPL)
Bronchiectasis is possible in those presenting with persistent cough (Photograph: SPL)

Common causes in adults
Asthma may present with a persistent dry cough that is worse at night or on lying flat for a time. There may be a wheeze that is aggravated by exercise.

COPD is usually associated with smoking. There is decreased exercise tolerance and a productive cough in the mornings.

A post-nasal drip is associated with clearing the throat regularly and posterior pharyngeal secretions.

TB is possible if there are night sweats, weight loss, haemoptysis, upper chest pains, and possible contact history.

Gastro-oesophageal reflux disease (GORD) may present with heartburn or reflux and is exacerbated by leaning forward and lying flat. It may also be related to hiatus hernia.

A smoker's cough lasting up to an hour in the mornings often produces green or brown sputum. Occupational causes include vapour or asbestos inhalation, or high temperatures.

Less common causes
Left ventricular failure is usually accompanied by peripheral oedema and reduced air entry at both lung bases.

Interstitial lung disease may be indicated by history, such as asbestos exposure or bird-keeping.

Fibrotic lung conditions and bronchiectasis are possibilities. Clubbing of the fingers may be present.

ACE inhibitors may induce a cough about three weeks into treatment. Pneumonia is usually associated with systemic symptoms including fever, malaise, and productive cough.

With malignancy there is haemoptysis, weight loss, chest pain, and a positive smoking history. Clubbing may occur. Metastatic disease of the lungs with a distant primary may present in a similar fashion.

A psychogenic or habitual cough is a diagnosis of exclusion.

Diagnosing children
Relatively common causes in children include asthma, with a nocturnal cough and cough and wheeze on activity. A trial of a short-acting beta-2 agonist inhaler using a spacer may be helpful.

Upper and lower respiratory infections may be associated with a cough that may last long after the infection has settled. Pertussis is on the increase.

Less common causes in children include GORD and cystic fibrosis, which should be suspected if there is chronic cough, failure to thrive, frequent chest infections and copious sputum. Urgent referral is indicated.

  • Dr Tinsley is a GP partner in Harrogate
Possible causes
  • Asthma
  • Post-nasal drip
  • GORD
  • Smoker's cough
  • Occupational
  • TB
  • Pneumonia

Less common

  • Left ventricular failure
  • ACE inhibitors
  • Malignancy
  • Psychogenic
  • URTI, lower respiratory tract infection and cystic fibrosis in children

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