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Asthma that has not previously been diagnosed or is poorly controlled requires referral. Diagnostic features are more than one of the following: wheeze, cough, dyspnoea and chest tightness, with symptoms often frequent and recurrent, worse at night and in the early morning, and triggered by exposure to pets, cold or damp air, emotions or exercise. A personal or family history of atopic disease, parental smoking, premature birth or low birth weight and having suffered bronchiolitis in infancy – these all can increase the risk of asthma
COPD symptoms typically include breathlessness upon exertion, chronic productive cough, wheeze and frequent chest problems during the winter months. Exercise intolerance, ankle oedema, fatigue and weight loss may also feature. Prevalence of COPD increases with age, with few cases diagnosed under 50 years. It is nearly always smoking related
Pertussis may be the culprit if a cough has lasted more than two weeks and features paroxysms of increasing severity and frequency, vomiting after coughing or the characteristic whooping sound. Those who have been in contact with someone with pertussis over the previous 14 days are at increased risk of developing the condition. Do not forget it is seen in adults as well as children
Lung cancer should be considered if someone has a persistent, unexplained cough (for longer than three weeks), or symptoms such as haemoptysis, chest or shoulder pain, breathlessness, weight loss, hoarseness, finger clubbing and stridor. It is more common in smokers, COPD patients and individuals who have been exposed to asbestos
Heart failure can present with cough associated with breathlessness, which is worse upon exertion, lying flat or waking in the morning. There may be a history of heart disease. Fatigue and fluid retention are other signs. Prevalence increases with age.
Conditions associated with cold and flu (2)
