Cough differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karina Zavaleta, MD [2], Anmol Pitliya, M.B.B.S. M.D.[3] Abiodun Akanmode,M.D.[4]


Making a differential diagnosis when a patient presents with a cough can be challenging however when the clinician ask about the other associated symptoms such as fever, vomiting, night sweats, weight loss, sputum production and quantity, smoking history, drug use and most importantly the duration of the cough,making a differential diagnosis becomes less challenging.

Cough Differential Diagnosis

For the differential diagnosis of productive cough, click here.
For the differential diagnosis of acute cough, click here.
For the differential diagnosis of chronic cough, click here.
For the differential diagnosis of cough and hemoptysis, click here.
For the differential diagnosis of cough and weight loss, click here.
For the differential diagnosis of cough and fever, click here.
For the differential diagnosis of cough and wheeze, click here.
For the differential diagnosis of cough, fever, and hemoptysis, click here.
For the differential diagnosis of cough, fever, and weight loss, click here.
For the differential diagnosis of cough, hemoptysis, and weight loss, click here.

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Respiratory Upper airway diseases Epiglottitis[1][2] Abrupt or acute
  • 12−24 hours
+ +
  • Elevated white blood count in CBC
  • Blood culture may show bacterial growth
  • Epiglottal culture in intubated patients may show bacterial growth
  • Normal function
Croup[3] Acute
  • 3−5 days
+ + +
  • Clinical diagnosis.
  • Laboratory findings and imaging are not necessary for diagnosis
Pertussis[4][5] Acute
  • Two weeks
+ Whooping sound + + +
  • Clear chest
  • Normal function
  • Culture
Laryngopharyngeal reflux[6][7] Chronic
  • Variable
+ +
  • Normal function
  • 24 hour−dual sensor pH probe
Common Cold[8] Acute
  • 3−10 days
+ +
  • Bacterial culture is not indicated
  • Normal function
  • Clinical diagnosis
Seasonal Influenza [9] Acute
  • 5−10 days
+ +
  • Normal function
  • Clinical diagnosis
Rhinosinusitis[10][11] Acute, subacute, chronic, recurrent
  • Acute: Less than 4 weeks
  • Subacute: 4−12 weeks
  • Chronic: More than 12 weeks
  • Recurrent: 4 or more episodes or acute rhinosinusitis per year
+ + +
  • Clear chest
  • Air−fluid level, mucosal edema and bony erosion of sinus on CT
  • MRI for distinguish the etiology
  • Normal function
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Respiratory Lower airway Asthma[12] Chronic
  • Years
+ Clear mucoid or yellow sputum +
  • Family history
  • Seasonal variation
Acute Bronchitis[13] Acute
  • From 5 days to 1 or 3 weeks
+ +/− +
  • FEV1 < 80%
  • Clinical diagnosis
Chronic Bronchitis[14][15] Chronic
  • Most of the days for three months in the las two years.
+ Clear sputum + +
Non−asthmatic eosinophilic bronchitis[16][17] Chronic
  • More than 8 weeks
+ Eosinophilic sputum +
  • Exposure to an occupational cause
Bronchiectasis[18] Chronic
  • Months to years
+ Mucopurulent sputum + +
  • CT of chest
Emphysema [19] Chronic
  • Months to years
+ Mucoid or purulent sputum + +
  • Exposure of tobacco and air pollution
Foreing body aspiration[20][21][22] Acute
  • Variable
+ + + +
  • No specific tests
  • Not specific
  • In children <1 year and adults >75 years
  • Organic materials in children
  • Inorganic materials in adults
Bronchiolitis[23][24] Acute
  • 8−15 days
+ + +
  • Clinical diagnosis
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Respiratory Parenchyma Pneumonia[25][26] Acute
  • Variable
+ Mucopurulent sputum + +
  • Not specific
Pneumoconioses[27][28] Acute, Chronic
  • Years
+ + +
Lung cancer[29][30] Chronic
  • Years
+ + + +/− + The following investigations may be helpful:
  • Not specific
Interstitial lung disease[31][32] Chronic
  • Variable
+ + + The following investigations may be helpful:
  • Lung biopsy when lab, imaging, and PFT has indeterminate result
Tuberculosis (TB)[33][34] Chronic
  • More than 2 or 3 weeks
+ + + + +
Cystic fibrosis (CF)[35][36] Chronic
  • Variable
+ + +/− +
  • Evidence of CFTR dysfunction
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Cardiac Cardiogenic pulmonary edema[37][38] Acute
  • Days to weeks
+ Pink frothy, liquid + + The following investigations may be helpful:
  • Not specific
  • Clinical diagnosis
  • Tests are supportive
Mitral Stenosis[39][40] Chronic
  • Variable
+ Pink frothy + +
  • Not specifc
Pulmonary hypertension[41][42] Chronic
  • More than 2 years
+ + + The following investigations may be helpful:
Gastrointestinal Gastroesophageal reflux[43][44] Chronic
  • Variable
+ + +
  • Not specific
  • Normal function
  • PH testing
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Autoimmune Goodpasture syndrome[45][46] Chronic
  • Variable
+ + The following investigations may be helpful:
  • Pulmonary infiltratation in chest X−Ray
  • CT scan for parenchymal involvement
Wegener's disease (GPA) [47][48] Chronic
  • Months
+ + + + + The following investigations may be helpful:
Sarcoidosis[49][50] Chronic
  • Years
+ + + The following investigations may be helpful:
Microscopic polyangitis (MPA)[51] Chronic
  • Variable
+ + + + + The following investigations may be helpful:
Churg−Strauss[52][53] Chronic
  • Variable
+ + + + +
  • Infiltrates in chest X−Ray
  • Ground glass opacities, tree−in−bud sign and small nodules in chest CT
Medication ACE inhibitors[54][55] Acute (depend on the medication)
  • From 2 weeks to 6 months
  • Not indicated
  • No indicated
  • Normal function
  • Clinical diagnosis
  • Resolves in four to five days of stopping the medication
  • Angioedema


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