Cough And Sputum Production - Clinical Methods - NCBI Bookshelf

Technique

A careful history, the most helpful task in the evaluation of patients with cough, will suggest the diagnosis of its cause in most instances. If the cough is not a part of the patient's presenting symptoms, its presence or absence should be determined by pointed questions not only directed to the patient but also to the spouse or other family members, as the patient may be unaware of a cough or may underestimate its frequency and duration. For example, it is not uncommon for patients with chronic bronchitis to be oblivious to their frequent coughing, while people around them are quite annoyed by it. Some patients may perceive their cough as "throat clearing." Many times, the truth about the patient's cough reveals itself to the observer during the interview and physical examination.

Once it is acknowledged that the patient has a cough, adequate information about its characteristics and circumstances should be obtained by appropriate questioning:

1. Was the onset of the cough sudden or insidious? What was its initiating event? Did it start as an isolated symptom or occur with or follow other symptoms?
2. How long has the cough been present? Is it persistent or episodic? Seasonal or perennial?
3. To determine the severity of the cough, ask: How frequent is a coughing spell? How long does each coughing spell last? What is its effect on daily activity or rest?
4. Is the cough productive or dry? Lack of expectoration does not necessarily indicate that the cough is dry, as many patients, particularly children and women, tend to swallow their sputum raised to the level of the pharynx. The sound of the cough would help in determining its productive or dry nature. Patients with sputum production should be asked about its frequency and description of the physical characteristics of the sputum including the amount (with each coughing spell and daily total), color, consistency, ease of its expectoration, taste, and smell.
5. Is the cough the only symptom, or is it associated with other respiratory or nonrespiratory symptoms? Inquiry should be specifically made about conditions known to cause the cough, particularly when it is chronic and persistent.
6. In addition to an accurate smoking history (see Chapter 40), ask: To what respiratory irritants is the patient exposed at home or at work? Is exposure accidental or intentional?
7. What are the precipitating or aggravating factors? What time of the day or night is the cough or sputum production worse? Does it happen in supine position, upon arising in the morning, with drinking or eating, with exercise, or with breathing cold or dry air? Does the cough awaken the patient from sleep?
8. Is there a past history (recent or old) of foreign body aspiration?
9. Has the pattern of the cough and the amount or other characteristics of the sputum changed recently?
10. Can the patient locate the site of origin of the cough or the sputum, such as from the throat or deeper in the chest?
11. Has the patient had a similar problem with coughing in the past?
12. Does the cough have easily recognizable characteristics, as in croup or whooping cough?