Chronic Cough

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍month history of cough

Described as ‍dryproductive, with ‍noclearyellowgreenwhite sputum

Severity is ‍mildmoderatesevere

Occurs most frequently during the ‍day

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍rhinorrhea, ‍clearcolored

‍nasal congestion

‍post-nasal drip

‍shortness of breath

‍wheezing

‍chest tightness

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍hemoptysis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍fatigue

‍night sweats

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍hoarseness



Contributing factors:

‍smokingpast smoking

‍similar symptoms in close contacts

‍occupational exposure to irritants

‍exposure to tuberculosis

‍recent Covid-19

no history of: ‍asthma, ‍chronic obstructive pulmonary disease, ‍allergic rhinitis, ‍pneumonia, ‍GERD, ‍lung cancer, ‍tuberculosis

no use of: ‍ACE inhibitors





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Chronic cough ‍likelysuspectedpossible

DDx: post-nasal drip, chronic bronchitis, GERD, asthma, COPD, bronchiectasis, lung cancer, tuberculosis, ACEI-induced cough, non-asthmatic eosinophilic bronchitis, interstitial lung disease, heart failure, pertussis, allergic rhinitis, chronic sinusitis, foreign body aspiration, occupational lung diseases





PLAN:

Investigations:

- Chest X-ray

- CT scan of the chest

- Pulmonary function tests

- Bronchoscopy

- Sputum culture

- Allergy testing

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍CRP, ‍LFTs, ‍blood culture

- Tuberculosis test

- CT of the sinuses

Treatments:

- Saline nasal irrigation

- ‍Nasal Steroids

- ‍Cough suppressants

- ‍Expectorants

- ‍Inhalers

- ‍PPIs

- ‍Antibiotics

- ‍Anti-histamines

- Smoking cessation counseling

- Avoid exposure to irritants (smoke, dust, chemicals)

- Stop ACE inhibitors

Further care:

- Referral to pulmonologist

- Referral to ENT specialist

- Referral to allergist

- Follow-up in ‍ ‍daysweeks

- Return if cough persists for more than 3 weeks, if new symptoms develop, or if condition worsens