Algorithm for differential diagnosis of cough by primary care physician

Abstract

SummaryCough is a common symptom that occurs in diseases of many organs and systems: respiratory, cardiovascular, digestive, endocrine, nose/ ear/ throat pathology, as well as mental disorders. Cough is an unconditioned reflex that occurs in response to direct irritation of specific cough receptors in diseases or when the cough center is stimulated. The causes of acute, subacute, and chronic cough are various but not always obvious. To determine them, one needs appropriate knowledge, thorough clinical examination, including medical history and complaints, and the necessary lab tests. The greatest attention should be paid to the diagnosis of chronic cough and the exclusion of those causes of cough that are life-threatening. Alarming symptoms are hemoptysis, prolonged persistent cough, which appears for the first time and does not stop, prolonged intoxication syndrome, resistance to ongoing therapy, weight loss, nocturnal cough, etc. For more in-depth diagnosis, additional examination methods are carried out, such as computed tomography of the chest, magnetic resonance tomography and bronchoscopy. The appointment of a general practitioner is strictly time-limited, which does not allow for a full diagnosis and determination of true cause of the cough. As a result, the patient is prescribed therapy aimed at suppressing the cough, and not at eliminating it. Algorithms and differential diagnosis schemes can help the doctor quickly determine the cause of the cough and prescribe the correct treatment.