Browse categories and answer follow-up questions to refine your symptom profile.
History
Context and trajectory
Symptom overview
Time course
Pattern
Progression
Baseline respiratory status
Prior similar episodes
Onset
Onset details
Sudden
Gradual
Triggering event
Temporal relation to illness
Provocation/Palliation
Modifiers
Worse with exertion
Worse at night
Worse supine
Worse with cold air
Worse with allergens
Relief with bronchodilator
Relief with antitussive
Quality
Cough character
Dry
Productive
Paroxysmal
Barking
Whoop
Posttussive emesis
Hemoptysis
Region/Radiation
Associated location features
Throat irritation
Chest tightness
Pleuritic pain
Upper airway congestion
Severity
Severity and impact
Sleep disruption
Dyspnea with speech
Activity limitation
Syncope or presyncope with cough
Frequency per hour
Timing
Timing pattern
Daytime predominant
Nocturnal predominant
Postprandial
Seasonal
After viral illness
Duration category
Acute under 3 weeks
Subacute 3 to 8 weeks
Chronic over 8 weeks
Associated symptoms
Associated symptoms cluster
Fever
Dyspnea
Wheeze
Sore throat
Rhinorrhea
Chest pain
Heartburn
Hoarseness
Weight loss
Night sweats
Exposure and context
Exposures
Sick contacts
Travel
TB exposure risk
Occupational inhalants
Smoke exposure
Vaping exposure
Animal exposures
Special populations history
High risk context
Immunocompromised state
Pregnancy
Anticoagulation use
Chronic lung disease history
Congestive heart failure history
Pediatric specific history
Pediatric features
Age under 3 months
Feeding intolerance
Wet diaper count
Apnea episodes
Color change episodes
Vaccination status
Foreign body aspiration concern
Alarm Features
Immediate escalation triggers
Resuscitation triggers
Airway compromise
Stridor at rest
Cyanosis
Apnea
Exhaustion
Altered mental status
Silent chest
Inability to speak full sentences
Vital sign danger thresholds
High risk vitals
Oxygen saturation under 90 percent on room air
Respiratory rate rising trend
Hypotension
Fever with toxicity
Persistent tachycardia
Hemoptysis and bleeding risk
Bleeding red flags
Large volume hemoptysis
Anticoagulation with hemoptysis
Hemodynamic instability
Airway contamination risk
Infection and sepsis red flags
Severe infection indicators
Rigors
Confusion
Lactate elevation if obtained
New hypoxia
Multifocal crackles with toxicity
Pulmonary embolism red flags
PE concern features
Pleuritic chest pain with dyspnea
Syncope
Unilateral leg swelling
Hemoptysis with risk factors
Malignancy and TB red flags
Serious chronic disease indicators
Weight loss
Night sweats
Persistent focal abnormal chest exam
Persistent hemoptysis
Known cancer history
Pediatric red flags
Pediatric danger features
Age under 3 months with respiratory symptoms
Poor feeding or dehydration
Apnea
Lethargy
Grunting
Nasal flaring
Retractions severe
Medications
Current and recent medications
Medication reconciliation
Prescribed medications
OTC medications
Recent antibiotics
Recent steroids
Inhalers
Nebulized therapies
Recent medication changes
Medication causes of cough
Offending agents
ACE inhibitor associated cough
Beta blocker bronchospasm risk
NSAID induced bronchospasm risk
Inhaled irritants
High risk medication interactions
Interaction considerations
QT prolonging combinations if macrolide considered
Warfarin interactions with antibiotics
Sedating antitussives in older adults
Opioid risk in pediatric patients
Diet
Intake and reflux triggers
Dietary context
Poor oral intake
Dehydration risk
Postprandial cough
Heartburn symptoms
Late evening meals
Caffeine and stimulant exposure
Stimulant intake
Caffeine
Energy drinks
Symptom association with intake
Review of Systems
Respiratory
Respiratory symptoms
Dyspnea
Wheeze
Pleuritic pain
Sputum change
Hemoptysis
Orthopnea
Paroxysmal nocturnal dyspnea
Infectious and constitutional
Systemic symptoms
Fever
Chills
Myalgias
Fatigue
Weight loss
Night sweats
ENT and GI
Upper airway and reflux
Rhinorrhea
Postnasal drip
Sore throat
Hoarseness
Heartburn
Dysphagia
Cardiac and vascular
Cardiovascular symptoms
Chest pressure
Palpitations
Syncope
Leg swelling
Calf pain
Collateral History and Family History
Collateral sources and reliability
Collateral
Source
Reliability
Symptom timeline confirmation
Medication confirmation
Family history
Familial conditions
Asthma
Atopy
Cystic fibrosis (E84.9)
Early cardiovascular disease
Thrombophilia history
Risk Factors
Infection and exposure risks
Exposure risks
Close contact with respiratory illness
Recent travel
Congregate living
Health care exposure
Aspiration risk
Pulmonary embolism risks
Thrombosis risks
Recent surgery or immobilization
Prior VTE
Active malignancy
Estrogen therapy
Pregnancy and postpartum
Chronic lung and airway risks
Airway risks
Asthma history (J45.909)
COPD history (J44.9)
Smoking history
Vaping history
Occupational exposures
Immunocompromised risks
Host risks
HIV or AIDS (B20)
Chronic steroid use
Transplant history
Chemotherapy
Neutropenia
Differential Diagnosis
Life threatening
Life threatening causes
Airway foreign body (T17.9)
Sudden onset
Unilateral wheeze
Choking episode
Severe asthma exacerbation (J45.901)
Silent chest
Accessory muscle use
Hypercapnia risk
Anaphylaxis (T78.2)
Urticaria
Hypotension
Angioedema
Pulmonary embolism (I26.99)
Pleuritic pain
Unexplained hypoxia
Risk factors present
Pneumonia with respiratory failure (J18.9)
Hypoxia
Toxic appearance
Focal consolidation
Heart failure with pulmonary edema (I50.9)
Orthopnea
Crackles
Elevated JVP
Tension pneumothorax (J93.0)
Sudden pleuritic pain
Unilateral absent breath sounds
Hemodynamic compromise
Massive hemoptysis
Airway flooding risk
Hemodynamic compromise
Common
Common causes
Viral upper respiratory infection
Rhinorrhea
Sore throat
Self limited course
Acute bronchitis (J20.9)
Cough under 3 weeks
No focal consolidation
Asthma exacerbation (J45.901)
Wheeze
Response to bronchodilator
COPD exacerbation (J44.1)
Increased sputum volume
Increased sputum purulence
Postnasal drip syndrome
Throat clearing
Nasal congestion
Gastroesophageal reflux disease (K21.9)
Heartburn
Postprandial cough
Less common and cannot miss
Less common causes
Pertussis (A37.9)
Paroxysmal cough
Posttussive emesis
Prolonged course
Tuberculosis (A15.0)
Night sweats
Weight loss
Hemoptysis
Medication induced cough
ACE inhibitor exposure
Temporal relationship to start
Interstitial lung disease (J84.9)
Dry cough
Exertional dyspnea
Lung malignancy (C34.90)
Persistent cough
Hemoptysis
Weight loss
Aspiration pneumonitis
Vomiting event
Altered mental status risk
Croup in pediatrics (J05.0)
Barking cough
Stridor
Bronchiolitis in pediatrics (J21.9)
Age under 2 years
Diffuse wheeze
Epiglottitis (J05.1)
Drooling
Tripod posture
Toxic appearance
Past Medical History
Relevant comorbidities
Comorbid history
Asthma
COPD
Heart failure
Coronary artery disease
Chronic kidney disease
Diabetes mellitus type 2 (E11.9)
GERD
Prior events and baseline
Prior respiratory course
Prior ICU admissions
Prior intubations
Home oxygen use
Baseline exercise tolerance
Prior VTE
Procedures and devices
Procedures and devices
Tracheostomy history
Home ventilation
Implanted cardiac devices
Recent endoscopy or sedation
Physical Exam
General and vitals interpretation
General assessment
Work of breathing
Ability to speak
Toxic appearance
Hydration status
Mental status
Vital signs pattern
Oxygen saturation trend
Fever pattern
Tachycardia correlation with distress
Blood pressure adequacy
Respiratory exam
Lung findings
Wheeze
Crackles
Rhonchi
Stridor
Focal decreased breath sounds
Prolonged expiratory phase
Use of accessory muscles
Retractions in pediatrics
ENT and upper airway
Upper airway findings
Nasal congestion
Oropharyngeal erythema
Tonsillar exudate
Uvular deviation
Drooling
Voice change
Cardiac and volume status
Cardiovascular findings
JVP elevation
Peripheral edema
New murmur
S3 gallop
Capillary refill
Extremities and thrombosis signs
DVT findings
Unilateral calf swelling
Calf tenderness
Asymmetric edema
Focused neurologic and safety
Neurologic and safety
Agitation from hypoxia
Somnolence from hypercapnia
Ability to protect airway
Lab Studies
Core labs by scenario
Targeted labs
CBC for suspected infection
Electrolytes for dehydration or beta agonist effects
Creatinine for contrast planning
Venous blood gas for ventilatory failure concern
Lactate for sepsis concern
Infectious testing
Pathogen tests
Viral PCR local protocol dependent
Influenza testing when antiviral decision dependent
SARS CoV 2 testing when isolation or therapy decision dependent
Pertussis PCR when paroxysmal cough over 2 weeks
Biomarkers and limitations
Biomarkers
Procalcitonin local protocol dependent
BNP for heart failure probability support
D dimer for low risk PE pathways
Pitfalls
Normal WBC does not exclude pneumonia
Early viral testing false negatives possible
D dimer elevated in pregnancy and inflammation
Imaging
Scoring Systems
Pneumonia severity tools
CURB 65
PSI
Utility
Admission risk support
Discharge support with stability
Limitations
Not validated for severe immunocompromise
Clinical judgment required
PE risk tools
Wells criteria
PERC
Age adjusted D dimer
Use when low or intermediate pretest probability
Avoid when high pretest probability
MRI
MRI role
Limited role in undifferentiated cough
Consider when alternative diagnosis suspected
Mediastinal mass characterization
Cardiac MRI for myocarditis concern
CT
CT indications
CT pulmonary angiography for PE evaluation
CT chest for malignancy or ILD concern
CT neck for deep space infection concern
CT cautions
Contrast nephropathy risk discussion
Contrast allergy history
Pregnancy radiation risk minimization
Ultrasound
POCUS lung and heart
B lines for pulmonary edema support
Pleural effusion identification
Consolidation patterns
Right heart strain supportive findings for PE
POCUS pitfalls
Operator dependence
Limited sensitivity for small pneumothorax in some windows
Special Tests
Bedside respiratory assessment
Bedside tests
Peak expiratory flow for asthma severity trending
End tidal CO2 for ventilatory status trending
Ambulatory oximetry for exertional desaturation
Microbiology and airway evaluation
Focused diagnostics
Sputum culture in severe pneumonia or immunocompromised
Blood cultures in septic physiology
TB testing pathway local protocol dependent
Bronchoscopy referral pathway for persistent hemoptysis
Pediatric focused tests
Pediatric diagnostics
Nasopharyngeal suction sample when bronchiolitis management depends on cohorting
Foreign body evaluation pathway
Sudden onset with asymmetric exam
Consider rigid bronchoscopy consult
ECG
When ECG helps
ECG indications
Chest pain with cough
Dyspnea disproportionate to exam
PE concern
Syncope with cough
High risk patterns
ECG red flags
New ischemic changes
New right heart strain pattern
New arrhythmia
QT prolongation before QT active antibiotics
Assessment
Problem representation
Working problem list
Cough with stability status
Hypoxia presence
Bronchospasm presence
Focal lung findings presence
Hemoptysis presence
Leading diagnoses with risk tier
Likely diagnosis tiering
Viral bronchitis
Stable vitals
No focal consolidation
Asthma exacerbation (J45.901)
Wheeze
Bronchodilator response
Pneumonia (J18.9)
Fever
Focal findings
Heart failure (I50.9)
Orthopnea
B lines or edema signs
Uncertainty and cannot miss
Must not miss list
PE (I26.99)
Pneumothorax (J93.9)
Severe asthma (J45.901)
Epiglottitis (J05.1)
Foreign body (T17.9)
Plan
First 5 minutes workflow
Initial stabilization
Monitor
Cardiac monitor
Pulse oximetry
Noninvasive blood pressure
Oxygen strategy
Nasal cannula for mild hypoxia
Nonrebreather for moderate hypoxia
High flow nasal cannula when persistent hypoxia with increased work
Airway readiness triggers
Rising CO2 concern
Exhaustion
Altered mental status
IV access criteria
Hypoxia requiring high flow
Sepsis concern
Need for IV medications
Diagnostic sequencing
Diagnostic pathway
Chest radiograph when pneumonia or heart failure concern
Viral testing when changes isolation or therapy
PE pathway
Risk stratification tool
D dimer when appropriate
CT pulmonary angiography when indicated
Blood gas strategy
Venous blood gas for ventilatory failure concern
Arterial blood gas when severe hypoxia with unclear cause
Therapeutics by phenotype
Bronchospasm treatment
Salbutamol inhaled 4 to 8 puffs via spacer
Repeat every 20 minutes for 1 hour if severe
Ipratropium inhaled 4 to 8 puffs via spacer
Prednisone PO 50 mg once daily
Duration 5 days local protocol dependent
Pneumonia treatment
Antibiotic selection local protocol dependent
Avoid antibiotics for uncomplicated acute bronchitis
Sepsis bundle when shock physiology
Croup treatment
Dexamethasone PO or IM 0.6 mg per kg
Maximum 10 mg
Nebulized epinephrine for stridor at rest local protocol dependent
GERD and upper airway cough syndrome pathway
Trial therapy outpatient when stable
Avoid empiric antibiotics
Reassessment loop
Reassessment timing
After each bronchodilator cycle
Every 30 to 60 minutes in moderate respiratory distress
Vital sign trend documentation
Oxygen requirement trend
Work of breathing trend
Consultation plan
Consult triggers
ENT for suspected epiglottitis or deep neck infection
Pulmonology for persistent hemoptysis or suspected ILD
ICU for escalating oxygen requirement or hypercapnia
Pediatrics for infant respiratory distress
Disposition
ICU and monitored bed criteria
Higher level of care criteria
Persistent hypoxia despite high flow oxygen
Rising CO2 with altered mental status
Hemodynamic instability
Severe work of breathing with fatigue
Massive hemoptysis risk
Admission and observation criteria
Inpatient or observation criteria
Pneumonia with hypoxia
Inability to maintain oral intake
High risk comorbidities with instability
Recurrent bronchodilator needs
Social unreliability for follow up
Discharge criteria
Discharge criteria
Stable oxygen saturation on room air or baseline
Improved work of breathing
Tolerating oral intake
Clear follow up plan
Return precautions understood
Pediatric disposition criteria
Pediatric disposition
Age under 3 months with symptoms requires low threshold admission
Persistent retractions or apnea observation
Caregiver reliability for home monitoring
Discharge Instructions
Copy discharge instructions
Discharge text
Today you were seen for cough
Your exam and tests did not show an emergency cause based on what was done today
Take medications exactly as prescribed
Use your inhaler as directed if you have wheezing or asthma
Drink fluids and rest as needed
Avoid smoking and vaping exposure
Follow up with your primary care clinician within 2 to 3 days if not improving
Return to the emergency department now for breathing trouble
Return to the emergency department now for lips or face turning blue
Return to the emergency department now for chest pain
Return to the emergency department now for fainting
Return to the emergency department now for coughing up blood
Return to the emergency department now for worsening fever or severe weakness
For infants and children return now for poor feeding
For infants and children return now for fewer wet diapers
For infants and children return now for pauses in breathing
References
Guidelines and decision tools
Key sources
American College of Chest Physicians cough guidelines 2006 with updates
European Respiratory Society chronic cough guideline 2020
British Thoracic Society clinical statement chronic cough 2023
IDSA ATS community acquired pneumonia guideline 2019
Global Initiative for Asthma strategy report 2024
American Academy of Pediatrics bronchiolitis guideline 2014 reaffirmed updates local protocol dependent
Project instructions source
Formatting constraints applied
Checkbox only structure applied
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.