History-taking
CPSA · Focused history · Respiratory
Cough
Duration separates acute (usually infective) from chronic cough, and the associated symptoms point to the cause. Always screen for the red flags of malignancy and TB.
Focused questions
Characterise
- Duration (acute <3 wk vs chronic >8 wk), dry vs productive, sputum colour/volume, haemoptysis, diurnal/nocturnal, triggers
Associated
- Breathlessness, wheeze, chest pain, fever, weight loss, night sweats, reflux, postnasal drip, ACE-inhibitor use
Red-flag screen
- Haemoptysis, weight loss, night sweats (malignancy/TB), smoking pack-years, TB contacts/travel, occupational exposure
Differentials to screen
Lower respiratory tract infection / pneumoniaAcute, fever, productive, focal signs
Asthma / COPDWheeze, diurnal, triggers, smoking history
Lung cancerChronic cough, haemoptysis, weight loss, smoker
TuberculosisChronic cough, night sweats, weight loss, contacts/travel
GORD / postnasal drip / ACE inhibitorChronic dry cough, reflux symptoms, drug history
Red flags — exclude these
- Haemoptysis
- Unintentional weight loss / night sweats
- Cough >3 weeks in a smoker (2-week-wait chest X-ray)
- Breathlessness at rest
OSCE tips
- Duration is the first discriminator: acute infective vs chronic.
- Always ask about haemoptysis, weight loss and night sweats (cancer/TB).
- A persistent cough on an ACE inhibitor is a common, easily-missed cause.