OLDCARTS Questions for Evaluating Cough
When assessing a patient with cough, a structured approach using the OLDCARTS mnemonic provides a comprehensive framework for understanding the illness and guiding diagnosis and management.
Onset
- When did your cough first begin? Was the onset sudden or gradual? 1
- Can you recall any specific event or illness that preceded the cough? 2
- Did the cough start after exposure to any new medications, environments, or substances? 2
Location
- Where do you feel the irritation that triggers your cough? Is it in your throat, upper chest, or elsewhere? 1
- Do you feel any pain or discomfort in your chest when you cough? 1
- Do you notice any postnasal drip or throat clearing associated with your cough? 1
Duration
- How long have you had this cough? (Less than 3 weeks, 3-8 weeks, or more than 8 weeks?) 2, 3
- Is the cough constant or does it come and go? 1
- Has the duration of coughing episodes changed over time? 2
Characteristics
- Is your cough dry or productive of sputum? If productive, what is the color, consistency, and amount of sputum? 1, 2
- Do you notice any blood in your sputum? 2
- Is the cough associated with wheezing, shortness of breath, or chest tightness? 2
Aggravating factors
- What makes your cough worse? (Examples: cold air, exercise, talking, eating, lying down) 1, 2
- Are there specific triggers like perfumes, smoke, or aerosols that worsen your cough? 1
- Does your cough worsen at particular times of day or in certain environments? 1
Relieving factors
- What helps relieve your cough? Have you tried any medications or home remedies? 2
- Does changing position (like sitting up) help with your cough? 1
- Does rest or avoiding certain activities improve your cough? 2
Timing
- Is your cough worse at any particular time of day or night? 1
- Does your cough wake you from sleep? 1
- Do you notice your cough occurs after meals or when lying down? 1
Severity
- On a scale of 1-10, how would you rate the severity of your cough? 2, 4
- How is your cough affecting your daily activities and quality of life? 4
- Has your cough caused any complications like urinary incontinence, vomiting, rib pain, or sleep disturbance? 1, 4
Additional important questions
- Do you smoke or have you smoked in the past? If so, how much and for how long? 1, 2
- Do you have any other medical conditions or take any medications regularly? 2
- Have you experienced any weight loss, fever, night sweats, or fatigue? 2
The thorough assessment of cough using OLDCARTS helps distinguish between common causes such as upper airway cough syndrome, asthma, gastroesophageal reflux disease, and postinfectious cough, allowing for targeted treatment approaches 2. Remember that chronic cough significantly impacts quality of life 4, with psychological aspects particularly affected in patients with chronic cough 1.