What symptoms should be asked in a patient with a 2-week history of cough?

Important Symptoms to Assess in a Patient with 2 Weeks History of Cough

When evaluating a patient with a 2-week history of cough, it is essential to assess for specific symptoms that can help determine the underlying cause and guide appropriate management.

Key Symptoms to Inquire About

Cough Characteristics

• Duration and progression of the cough (exactly how many days/weeks) 1
• Character of the cough - paroxysmal (sudden bursts of uncontrollable coughing), dry, or productive 1
• Sputum production - amount, color, consistency (clear, purulent, blood-streaked) 1
• Diurnal variation - whether cough is worse at night, morning, or after meals 1
• Presence of whooping sound during inspiration following coughing episodes 1

Associated Respiratory Symptoms

• Post-tussive vomiting (vomiting after coughing episodes) - highly specific for pertussis 1
• Shortness of breath - at rest or with exertion 1
• Wheezing or chest tightness 1
• Nasal symptoms - rhinorrhea, nasal congestion, post-nasal drip 1
• Throat symptoms - sore throat, frequent throat clearing 1

Constitutional Symptoms

• Presence or absence of fever - absence of fever with paroxysmal cough suggests pertussis 1
• Weight loss - may indicate tuberculosis or malignancy 1
• Night sweats 1
• Fatigue 1

Aggravating and Relieving Factors

• Environmental triggers - cold air, exercise, pollutants, allergens 1
• Response to previous treatments - antibiotics, inhalers, antihistamines 1
• Positional changes - worse when lying down (suggests GERD) 1
• Relation to meals - cough after eating suggests aspiration or GERD 1

Risk Factors and Exposures

• Smoking history - current or former smoker 1
• Occupational exposures - irritants, chemicals, dusts 1
• Recent travel history - especially to TB endemic areas 1
• Contact with persons with similar symptoms or known infectious diseases 1
• Vaccination status - particularly pertussis vaccination 1, 2

Medication History

• Current medications - particularly ACE inhibitors which can cause chronic cough 1
• Recent antibiotic use 1

Red Flag Symptoms

• Hemoptysis - coughing up blood 1
• Hoarseness persisting with cough 1
• Recurrent pneumonia 1
• Digital clubbing - suggests chronic lung disease 1
• Dysphagia - difficulty swallowing 1

Special Considerations

For Pertussis Evaluation

• In adults with 2-week cough, specifically assess for paroxysmal cough, post-tussive vomiting, inspiratory whooping, and absence of fever - these are key diagnostic features 1
• The absence of fever with paroxysmal cough strongly suggests pertussis 1
• Post-tussive vomiting and inspiratory whooping are highly specific for pertussis 1

For Tuberculosis Consideration

• In endemic areas or high-risk populations, TB should be considered regardless of cough duration 1
• Weight loss, night sweats, and hemoptysis are important symptoms to assess 1

For Children

• Paroxysmal cough, post-tussive vomiting, and whooping are particularly important to assess in children 1, 2
• Cough during feeding may suggest aspiration or anatomical abnormalities 1

A thorough assessment of these symptoms will help distinguish between common causes of cough lasting around 2 weeks, including viral or bacterial respiratory infections, pertussis, asthma, and early presentations of chronic conditions 1.