Differential Diagnosis for Coughing to the Point of Vomiting

Single Most Likely Diagnosis

• Pertussis (Whooping Cough): This is a highly contagious respiratory illness caused by Bordetella pertussis bacteria. It's known for causing severe coughing fits that can lead to vomiting, especially in children and individuals who are not vaccinated or have waning immunity.

Other Likely Diagnoses

• Asthma: Severe asthma attacks can cause intense coughing, which may lead to vomiting due to the prolonged and forceful nature of the cough.
• Chronic Obstructive Pulmonary Disease (COPD): Similar to asthma, severe COPD exacerbations can result in violent coughing spells that may induce vomiting.
• Pneumonia: Certain types of pneumonia, especially those caused by viral or mycoplasma infections, can lead to severe coughing that may result in vomiting.
• Gastroesophageal Reflux Disease (GERD): Although primarily associated with heartburn, severe GERD can trigger coughing fits, especially when stomach acid refluxes into the esophagus and irritates the respiratory tract, potentially leading to vomiting.

Do Not Miss Diagnoses

• Pulmonary Embolism: While less common, a pulmonary embolism can cause sudden onset of cough and may lead to vomiting due to the acute increase in pulmonary pressure and potential for right heart strain.
• Foreign Body Aspiration: Especially in children, aspiration of a foreign body can cause sudden, severe coughing that may lead to vomiting. This is a medical emergency requiring immediate attention.
• Cardiac Conditions (e.g., Heart Failure): Severe cardiac conditions can lead to pulmonary congestion, which may cause a cough severe enough to induce vomiting.

Rare Diagnoses

• Cystic Fibrosis: This genetic disorder can lead to severe respiratory symptoms, including coughing fits that may result in vomiting, due to the production of thick, sticky mucus that clogs the airways.
• Tuberculosis (TB): Although more commonly associated with chronic symptoms, active TB can cause severe coughing, potentially leading to vomiting, especially in advanced cases or in individuals with compromised immune systems.
• Eosinophilic Esophagitis: This condition, characterized by an eosinophil-predominant inflammation of the esophagus, can cause severe coughing and vomiting, particularly after eating or at night.