| Alternative or comorbid condition | Suggestive features |
| Inducible laryngeal obstruction | Dry cough or breathing difficulty triggered by strong smells, irritants or exercise Symptoms worse when talking on the phone Symptoms associated with throat tightness or voice change Breathlessness worst at peak exercise. Inspiratory wheezing (stridor) – strongly suggests a laryngeal or upper airway abnormality |
| Rhinosinusitis | Cough co-occurring with symptoms of rhinosinusitis |
| Chronic upper airway cough syndrome | Dry cough is dominant symptom Throat-clearing Dysphonia ‘Scratchy’ throat Triggered by talking, laughing, strong odours or smoke May be associated with chronic rhinosinusitis or gastroesophageal reflux |
| ACE inhibitor-related cough | Cough is dominant symptom |
| COPD | Onset of dyspnoea/cough/ wheeze at age >40 years History of smoking or exposure to smoke/dust History of recurrent chest infections Persistent breathlessness Family history of emphysema |
| Bronchiectasis | Productive cough in a patient with a history of recurrent infections |
| Large airway stenosis | Breathlessness or wheeze |
| Pulmonary fibrosis | Breathlessness or dry cough Fine crackles heard during inspiration on auscultation |
| Lung cancer | Persistent cough despite treatment Haemoptysis Chest pain Weight loss |
| Poor cardiopulmonary fitness | Breathlessness on exertion |
| Heart disease | Chest tightness on exertion Dyspnoea on exertion or when lying flat Basal crepitations |
| Pulmonary embolism | Sudden-onset dyspnoea |
| Dysfunctional breathing | Breathlessness with dizziness, light-headedness, or tingling fingers |
| Panic attacks | Breathlessness or chest tightness at rest or on minor exertion, accompanied by anxiety |
| Gastro-oesophageal reflux disease | Cough or chest tightness in patient with symptomatic reflux |
| Recurrent respiratory infections | As clinically typical |
Additional information
ACE: angiotensin-converting enzyme; COPD: chronic obstructive pulmonary disease