There are many respiratory conditions that develop silently without a regular cough, especially in the early stages. Instead, they have subtler signs. Here are the three conditions the doctor outlined that may not always present with a cough:

• People with asthma may experience breathlessness, wheezing, or chest tightness without a persistent cough.
• These symptoms may occur during exercise, at night, early in the morning, or after exposure to dust, pollution, or allergens.
• Symptoms can disappear between episodes; people sometimes mistake them for poor fitness or an allergy.

• In chronic obstructive pulmonary disease (COPD), breathlessness may be an equally or even more important warning than coughing.
• A person may gradually find that climbing stairs, walking uphill or keeping up with friends has become more difficult.
• Rather than seeking medical attention, they may simply become less active and assume it is part of ageing.
• In smokers, this gradual change in exercise capacity should not be ignored.

• Early lung cancer can sometimes cause no symptoms.
• When symptoms develop, they may include a persistent or changing cough, coughing up blood, chest pain, unexplained weight loss, or recurrent chest infections.
• People with a history of smoking or other significant risk factors should discuss their risk with a doctor instead of waiting for symptoms to appear.

Breathlessness happens before a cough, and it is an equally important warning sign. Dr Shah highlighted pulmonary fibrosis as one condition in which changes in breathing and exercise capacity may be noticed first.

A change in your breathing may be more significant than whether you have a cough. Go see a doctor if you experience:

1. Unexplained or progressively worsening breathlessness
2. Wheezing
3. A decline in exercise capacity
4. Recurrent chest infections
5. Chest pain or discomfort
6. Coughing up blood
7. Unexplained weight loss

The doctor explained that, depending on a person's symptoms and risk factors, they may be advised to undergo spirometry, chest imaging, oxygen assessment, or other investigations.