Introduction: Patients with pulmonary TB present with a chronic productive cough, fever, and weight loss. Cough occurs in a variety of circumstances, notably in acute upper and lower respiratory infections. However, these acute infections often resolve within weeks. Cough in people with pulmonary TB disease arises as a result of the inflammatory response to mycobacterium pulmonary infection. Objectives: to assess the change of cough frequency and pulmonary T.B outcome. Method: observational study conducted in tertiary care hospital among all 250 in and out patients of pulmonary T.B. Data were entered first into Excel and then analyzed using STATA version 11.0 for Windows. Results: The study shows statistically significant association between 7 an 14 days and 14 and 30 days cough frequency improvement. The study shows as the cough frequency is improving (decrease in 24 hour), outcome is also going to be good at 7 and 14 days with a statistically significant P-value of 0.000. Conclusion: Thus, cough frequency during the first two weeks of therapy should be used as part of the routine clinical evaluation. Patients with unchanged or increased cough frequencies after two weeks of treatment should be more closely followed as they are at risk of adverse outcomes.