Cough with sputum

The majority of patients presenting with a productive cough will have a short history of days or weeks but many will have a background of a chronic cough.

Some differential diagnoses and typical outline evidence

Chronic bronchitis	Suggested by: grey sputum, slow progression over years and a smoker (nearly always).
	Confirmed by: grey sputum >3 months over two consecutive years.
	Management: OHCM p188.
Acute viral bronchitis	Suggested by: onset over hours or days. Fever, white/yellow sputum.
	Confirmed by: no consolidation on CXR, quick spontaneous resolution.
Acute bacterial bronchitis	Suggested by: onset over hours or days. Fever, mucopurulent sputum, dyspnoea.
	Confirmed by: sputum culture and sensitivities, response to appropriate antibiotics.
	Management: OHCM p188.
Pneumonia	Suggested by: onset over hours or days. Rusty brown sputum (i.e. purulent sputum tinged with blood). Sharp chest pain worse on inspiration, pleural rub, fever, cough, consolidation etc.
	Confirmed by: patchy shadowing on CXR and sputum/blood culture.
	Management: OHCM pp173–6.
Bronchiectasis	Suggested by: progression over months or years. Finger clubbing, cupful(s) of pus-like sputum per day. Coarse late inspiratory crepitations.
	Confirmed by: CXR: cystic shadowing; high resolution CT chest: honeycombing and thickened dilated bronchi.
	Management: OHCM pp178, 179.
Lung abscess	Suggested by: copious amount of foul smelling pus/brown sputum, haemoptysis, high swinging fever, chest pain over weeks, usually preceded by a prior significant respiratory infection (e.g. pneumonia).
	Confirmed by: fluid level in cavity on CXR, CT chest, response to physiotherapy, antibiotics and aspiration.
	Management: OHCM pp176, 618.