Problem Acute Inflammation Laryngitis Dry cough (without sputum), An acute, fairly minor illness with may become

productive of hoarseness. Often associated with viral variable amounts of sputum nasopharyngitis Tracheobronchitis Dry cough, may become An acute, often viral illness, with burning productive retrosternal discomfort Mycoplasma and Dry hacking cough, often An acute febrile illness, often with Viral Pneumonias29 becoming productive of mucoid malaise, headache, and possibly dyspnea sputum Bacterial Pneumococcal: sputum mucoid An acute illness with chills, high fever, 29 Pneumonias or purulent; may be blooddyspnea, and chest pain. Often preceded streaked, diffusely pinkish, or by acute upper respiratory infection rusty Klebsiella: similar; or sticky, Typically occurs in older alcoholic men red, and jellylike Chronic Inflammation Postnasal Drip Chronic cough; sputum mucoid Repeated attempts to clear the throat. or mucopurulent Postnasal discharge may be sensed by patient or seen in posterior pharynx. Associated with chronic rhinitis, with or without sinusitis Chronic Bronchitis4 Chronic cough; sputum mucoid Often long-standing cigarette smoking. to purulent, may be bloodRecurrent superimposed infections. streaked or even bloody Wheezing and dyspnea may develop. Bronchiectasis3 Chronic cough; sputum Recurrent bronchopulmonary infections purulent, often copious and common; sinusitis may coexist. foul-smelling; may be bloodstreaked or bloody Pulmonary Cough dry or sputum that is Early, no symptoms. Later, anorexia, 31 Tuberculosis mucoid or purulent; may be weight loss, fatigue, fever, and night blood-streaked or bloody sweats Lung Abscess Sputum purulent and foulA febrile illness. Often poor dental smelling; may be bloody hygiene and a prior episode of impaired consciousness Asthma28 Cough, with thick mucoid Episodic wheezing and dyspnea, but sputum, especially near end of cough may occur alone. Often a history of an attack allergy Gastroesophageal Chronic cough, especially at Wheezing, especially at night (often Reflux night or early in the morning mistaken for asthma), early morning hoarseness, and repeated attempts to clear the throat. Often a history of heartburn

TABLE 8-3 Cough2 and Hemoptysis* Cough and Sputum Associated Symptoms and Setting

and regurgitation Neoplasm Cancer of the Lung Cough dry to productive; Usually a long history of cigarette sputum may be blood-streaked smoking. Associated manifestations are or bloody numerous.

Cardiovascular Disorders Left Ventricular Failure or Mitral Stenosis

Often dry, especially on Dyspnea, orthopnea, paroxysmal exertion or at night; may nocturnal dyspnea progress to the pink frothy sputum of pulmonary edema or to frank hemoptysis 30 Pulmonary Emboli Dry to productive; may be dark, Dyspnea, anxiety, chest pain, fever; bright red, or mixed with blood factors that predispose to deep venous thrombosis Irritating Particles, Variable. There may be a latent Exposure to irritants. Eyes, nose, and Chemicals, or Gases period between exposure and throat may be affected. symptoms. * Characteristics of hemoptysis are printed in red.