Differential Diagnosis for Cough Worse When Lying Down

The patient's symptom of a cough worsening when lying down suggests several potential diagnoses, categorized as follows:

• Single Most Likely Diagnosis

  • Gastroesophageal Reflux Disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, which can trigger coughing, especially when lying down, as gravity facilitates the reflux of acid.

• Other Likely Diagnoses

  • Postnasal Drip: Also known as upper airway secretion syndrome, this condition involves the dripping of mucus from the back of the nose down into the throat, which can irritate the throat and trigger coughing, worsening when lying down due to increased mucus flow.
  • Asthma: Asthma can cause coughing that worsens at night or when lying down due to various factors, including increased airway resistance and exposure to allergens like dust mites in bedding.
  • Chronic Bronchitis: This condition, often associated with smoking, involves inflammation of the bronchial tubes, leading to a persistent cough that can worsen when lying down due to increased mucus production and pooling of secretions.

• Do Not Miss Diagnoses

  • Heart Failure: Congestive heart failure can lead to pulmonary edema, where fluid accumulates in the lungs, causing a cough that worsens when lying down (orthopnea) due to increased venous return and pulmonary congestion.
  • Pulmonary Embolism: Although less common, a pulmonary embolism can cause sudden onset of cough and shortness of breath that may worsen when lying down, due to increased pressure and potential for further clot dislodgement.

• Rare Diagnoses

  • Aspiration Pneumonia: This condition occurs when food, liquids, or other materials are inhaled into the lungs, potentially causing a cough that worsens when lying down due to increased risk of aspiration in the supine position.
  • Laryngopharyngeal Reflux (LPR): A subtype of GERD that affects the larynx and pharynx, LPR can cause chronic cough, hoarseness, and throat clearing, which may worsen when lying down due to increased exposure of the laryngopharyngeal area to acidic gastric contents.