Cough Case Study
University of South Florida
CASE ONE: Mrs. L. Windermere is a 73-year-old woman under your care for more than a decade. She has no chronic medical conditions and comes in once a year in the spring just to “catch up.” In this visit her only complaint is a cough. It started a month or two ago following a cold. She hadn’t been very ill – just some congestion and rhinorrhea. After those symptoms mostly resolved, she developed this cough. She asks, “Is there something you can give me for this cough?”
1. How is cough categorized? Is this a chronic cough?
According to Pratter, Brightling, Boulet, and Irwin, (2006), based on duration, cough can be divided into three categories: acute, lasting < 3 …show more content…
Patients complain of postnasal drip or frequent clearing of the throat and on physical examination one can see mucus in the oropharnyx or a cobblestone appearance, however, Tofts et al. (2011) concluded these symptoms and signs are not specific and may be absent. According to Pratter et al. (2006), the approach to UACS should typically begin with a diagnostic/therapeutic trial of a first-generation antihistamine-decongestant (A/D). Pratter et al. found that if a patient has resolution or partial resolution of cough in response to A/D therapy, then UACS is considered to have been the cause of cough and A/D therapy is continued.
CASE ONE CONTINUED: Three weeks later she returns to your office. She is still coughing. You tell her to stop the antihistamines and decongestant. You give her a month of a PPI thinking that perhaps this is reflux – even though she denies any heartburn symptoms. She comes back a month later. That didn’t work.
5. Now what?
According to Pratter et al. (2006) in patients whose chronic cough persists after treatment for UACS, the possibility that asthma is the cause of cough should be worked up next. Pratter et al. (2006) found the medical history is sometimes suggestive, but is not reliable in either ruling in or ruling out asthma. Bronchoprovocation challenge (BCP) should be