Synopsis
Classify cough by duration and phenotype, recognise infection, malignancy and suppurative lung disease, and investigate treatable traits without reflex antibiotics, acid suppression or repeated empirical inhalers.
- Define duration and pattern: acute cough is commonly viral, while chronic cough lasting more than eight weeks needs structured assessment of triggers, imaging, spirometry and treatable traits.
- Ask whether the cough is dry, productive, nocturnal, meal-related, positional or triggered by cold air, voice, fragrance, exercise or occupational exposure; each pattern changes the differential.
- Record sputum volume, colour, odour, blood and daily variability. Purulence reflects neutrophilic inflammation but does not by itself prove a bacterial infection needing antibiotics.
Key red flags
Haemoptysis, weight loss, persistent hoarseness, focal wheeze, lymphadenopathy, clubbing or recurrent pneumonia in one lobe warrants urgent imaging and cancer-pathway assessment, particularly in people aged forty or over with smoking or asbestos exposure.
Investigation priorities
Detect pneumonia, mass, collapse, interstitial change, heart failure or another structural cause.
Management branches
Cough of recent onset with stable physiology and no cancer, sepsis or airway red flags.
- Assess observations, chest signs, comorbidity and duration; identify pneumonia, asthma exacerbation, COVID-19 or influenza risk, pulmonary embolism and heart failure rather than assuming uncomplicated bronchitis.
- Give self-care advice and symptom relief appropriate to the person; NICE advises against routine antibiotics for uncomplicated acute cough because benefit is small and adverse effects and resistance are real.
Cough persisting beyond eight weeks without an established explanation.
Key medicines
ACE-inhibitor withdrawal when clinically appropriateStop the ACE inhibitor and substitute an appropriate alternative through the prescribing clinician; allow at least four weeks before judging cough response.
Proton-pump inhibitor for documented acid reflux symptomsUse an adequate guideline-concordant treatment course only when heartburn or other convincing acid-reflux evidence is present, then review and deprescribe if ineffective.