Cough History Taking | OSCE Tips

Cough history taking is a crucial skill that is frequently tested in OSCEs. This tutorial offers a methodical way to collect a cough history during an OSCE.

Presenting complaint (PC): 

What brought you here today? 

History presenting complaint (HPC):

Onset: when did it start? Is it constant or intermittent? 

Duration of cough: how long have you had the cough for? 

Note

• Cough is >3 months: COPD.

• Cough is worse at night: Asthma.

• Cough worse when lying flat: Heart failure or GORD.

 Frequency of cough: how often are you coughing? 

Type of cough (dry or productive): are you coughing up anything?

Note: 

• Dry cough likely: Asthma

• Coughing up blood : Pulmonary Embolism, Tuberculosis , Bronchiectasis or cancer. 

• Sputum production: Pneumonia 

• Pink, frothy sputum: Heart failure 

Precipitating or exacerbating factors: is it worse at night? Or during exercise? 

Associate symptoms: any wheeze, sore throat, chest pain, gastrointestinal symptoms,Recent respiratory tract infection, Recent travel history, Peripheral oedema fever?

Now is a good idea to ask Ideas, Concerns & Expectations (ICE) 

Past medical history (PMH): 

Is there any chronic illness that I should know about that we have not covered? 

If yes: ask about severity and if this has caused them to be admitted to hospital (for example an exacerbation of asthma requiring admission).  

Drug history (DH):

Are you taking any medication? If so, any side effects.

Note: common s/e from an ACEi (for example Ramipril) is a persistent dry cough. 

Family history (FMH): 

Is there any family history of asthma, eczema, heart disease or DVT/PE I should know about? 

Social History (SH): 

Do you smoke? Any recent travel? Occupation? 

Possible differential diagnosis:

Respiratory causes:

• Respiratory infection generally causes a productive cough, shortness of breath and fever.

• Asthma - nocturnal cough, intermittent wheeze, sob on exercises? Caused by a Pet? Environmental? 

• COPD - produce cough (chronic), sob, smoking history 

• Lung tumour - haemoptysis, weight loss, smoking history

• Pulmonary embolism (PE): sharp, pleuritic chest pain, hemoptysis, calf pain (symptoms of DVT), recent long travel, oral contraceptive. 

Cardiac causes: 

• Heart failure: pink frothy sputum, sob/cough worse when lying down

Gastrointestinal causes:

• Gastro-oesophageal reflux disease (GORD): cough worse with certain foods e.g spicy, heartburn symptoms, sensation of something stuck in throat. 

Investigation: 

• Bedside: respiratory examination, Oxygen saturation (SPO2), pulse/heart rate (HR), blood pressure (BP), respiratory rate (RR)

• Bloods : full blood count (FBC), urea and electrolyte (U&E), c-reactive protein (CRP) + Erythrocyte Sedimentation Rate (ESR) and Brain natriuretic peptide (BNP)

• Imaging: Chest XR 

• Spirometry 

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