Differential Diagnosis for Cough that Worsens with Lying Down
- 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, which may worsen with lying down due to increased pressure on the lungs and potential for further clot dislodgement.
- Rare Diagnoses
- Interstitial Lung Disease: Conditions like idiopathic pulmonary fibrosis can cause a dry cough that worsens when lying down due to increased pressure on the lungs and decreased lung volume.
- Laryngopharyngeal Reflux: A variant of GERD that affects the larynx and pharynx, causing symptoms similar to GERD but often with more pronounced voice and throat symptoms.
- Eosinophilic Esophagitis: An inflammatory condition of the esophagus that can cause difficulty swallowing and coughing, potentially worsening with lying down due to esophageal dysmotility and increased contact time between esophageal mucosa and allergens or irritants.