Acute Cough

An Acute Cough is one which has been going on less than 2-3 weeks.

Anyone with “acute cough” may not be allowed inside a building without a Covid Test. But some patients need to be seen no matter what; every office or clinic has its own mechanism, maybe in a designated exam room, maybe sending them to an Urgent Care or E.R.  These are patients who, in addition to a cough, also have:

Causes of Acute Cough

zzzUpper Respiratory Tract ConditionszzzLower Respiratory Tract Conditions
โ€ข Common Cold
โ€ข Allergic Rhinitis (Hay Fever; “Allergies”)
โ€ข Sinusitis
โ€ข Tracheitis (โ€œCroupโ€ in children under 3)
โ€ข Hypertension Medication (โ€œACE-Inhibitorsโ€)
โ€ข (if sudden onset while eating: Aspiration)
โ€ข Covid-19
โ€ข Influenza (& other viruses)
โ€ข Pneumonia (both common germs & rare)
โ€ข Asthma
โ€ข COPD (exacerbation)
โ€ข Acute Bronchitis
โ€ข Heart Failure
โ€ข Pertussis (โ€œwhooping coughโ€)  

For Anatomy, see: Diagram — Upper Respiratory Tract and Diagram — Lower Respiratory Tract. See also Acute Cough — Full Text for an in-depth discussion.

STEP #1  —  Is this Covid?  If going on under 2 wks, assume yes.  Get a Covid Test.

  • Test Positive ย โ†’ diagnosis made; itโ€™s Covid-19
  • Test Negative ย โ†’ย  Might still be, but go to Step #2.ย  May repeat test in 2-3 days; if still Negative, ย  most likely itโ€™s NOT Covid.
  • Results still pending ย โ†’ย  Isolate just in case.ย  If Dec.- April, and suspect Influenza (abrupt onset, fever, muscles aches, and going on less than 3-4 days). Test or just treat for Influenza

STEP #2ย  —ย  If not Covid, or test results pending, is the illness causing COUGH from
…..โ€ข Upper Respiratory Tract (from nose, sinuses, throat); or
…..โ€ข Lower Respiratory Tract (from the lungs); or
…..โ€ข We Canโ€™t Tell ?

Upper Respiratory:  Significant nasal symptoms (runny nose / sneezing / congestion); AND

  —  No Fever, No SOB, Normal Lung Exam (by stethoscope)

  • a mild fever is possible at beginning, goes away soon
  • fever can occasionally occur with Sinusitis

Lower Respiratory:  Any of the following

  • Fever, especially if also muscle aches
  • SOB [always a dangerous symptom, if it’s “true” SOB]
  • Abnormal Lung Exam (by stethoscope)

Canโ€™t Tell:  Just a โ€œCoughโ€

  • No nasal symptoms, No fever, No SOB
  • Normal Lung Exam (by stethoscope)

If We Think LOWER RESPIRATORY cause of COUGH (Covid tests Negative twice)
These may be dangerous; if Covid negative twice, or pending, seek other cause.

Fever &/or Muscle Aches  โ†’  Itโ€™s likely Influenza (or another SIMPLE Virus)… UNLESS

  • Going on over 3-4 days without getting even the least bit better
  • Rales (crackles) on lung exam (suspect Pneumonia)
  • SOB (always makes condition potentially more serious — must check oxygen level)
    • Low oxygen or significant SOB, we often send to E.R. for X-ray and immediate labs
  • If any of above, we get a Chest X-ray (will diagnose Pneumonia)
    • Also suspect Pneumonia if: Cough + Fever + Pain with Deep Breath
  • Also X-ray if:  Elderly / chronically ill / immunocompromised
    • May send such patients with Cough + Fever to the ER

Bronchospasm by Lung Exam (wheezes, rhonchi, OR prolonged expiration โ†’  Diagnose:

**ย  Viral Bronchitis (if first episode)

**ย  Asthma (if previous episodes)

**ย  Chronic Bronchitis (if smoker with history of COPD)

**ย  Heart Failure (bronchospasm is rare; consider it only if other factors too, see right below)

Shortness of Breath (SOB) —  (and No Fever, No Bronchospasm) [click to explain โ€œtrueโ€ SOB]

**ย  Asthma / Chronic Bronchitis : most likely, if otherwise healthy

  • Treat on-site.ย  If symptoms improveย  โ†’ Diagnosis made.

**ย  Heart Failure —ย  possible as cause of cough, especially if any of following:

  • Older age, or Risks for Heart Disease
  • SOBย when lying flat in bed, needs to sit up (this often happens with asthma too)
  • Findingsย on Exam: swollen feet, “rales” in both lungs (wheezes possible, very unusual)

For SOB not improved with asthma treatment, may need to send to ER, esp. if low oxygen

NOTE  —  if patient’s cough is minimal, & SOB is the more prominent symptom, itโ€™s a different thought process for diagnosis (see topic Shortness of Breath).


** Allergic Rhinitis:ย  any of the following:

  • Lots of sneezing
  • Similarย episodes in the past, especially if lasted over a month
  • Findingsย on exam (pale, boggy mucus membranes inside nose; darkened lower eyelids; horizontal crease across tip of nose on top)

**ย  Sinusitis (bacteria):

  • Facialย pressure / constant green mucus (esp. if only one side of face)
  • Tapย on upper teeth on one side makes the cheek hurt
  • Maybe a fever
  • Mainย Way to Diagnose Sinusitis — โ€œcommon cold,โ€ going on for a week, suddenly got a lot worse

**  Common Cold:   Neither of the above scenarios. Common Cold is always the most likely diagnosis for an acute cough

If We Canโ€™t Tell if it’s UPPER or LOWER RESPIRATORY
No Nasal symptoms, No fever, No SOB, Normal lung exam

** Tracheitis  —  Most likely diagnosis

** Pertussisย  —ย  Might be, if any of the following:

  • Vomit after coughing fits
  • Notย even starting to get better after 2 weeks
  • Contactย with unvaccinated infant makes possible-Pertussis risky enough to treat

** Asthmaย  —ย  Still a possibility (even though Lung Exam sounds normal)

  • Veryย likely if person already had similar episodes in past, or has been diagnosed already
  • Might diagnose new Asthma if no improvement in 2 weeks (too long for Tracheitis)
  • No danger waiting, as long as there’s no SOB
  • Can always treat with asthma medications (inhalers) anyway

EXTRA  —  Sudden Onset Coughing (Choking) While Eating

** Foreign Body Aspiration

  • Only perform a Heimlich if person can’t make a single sound
  • NEVER do a Heimlich on someone who’sย actively coughing
  • Call 911, best from a landline
  • Ifย it’s you, & you’re alone, open the door & stumble outside (see Calling 911)

See Acute Cough โ€” Full Text for more in-depth explanations and discussions.

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