MEDizzy - You are treating a 52-year-old woman with a 40-pack-year

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Acute Complaints

You are treating a 52-year-old woman with a 40-pack-year history of smoking. She reports a productive cough that has been present for the last 3 to 4 months, beginning in the fall. She remembers having the same symptoms last year in the fall, and attributed it to a “cold that she just couldn’t kick.” She does not have fevers, reports mild dyspnea when walking up stairs, and denies hemoptysis. Which of the following is the most likely diagnosis?

Explanationecause the patient reports a productive cough for at least 3 months of the year for at least 2 consecutive years, she meets the criteria for chronic bronchitis. This is acommon cause of chronic cough in smokers. Chronic bronchitis is a useful clinical designation, but falls under the broad category of chronic obstructive pulmonary disease (COPD). While it is true that her smoking may cause irritation of her airways, it wouldn’t explain why the cough isn’t present year-round (since she continues to smoke throughout the year). The most common cause of chronic cough in nonsmokers is postnasal drainage, but since this patient has a significant smoking history, chronic bronchitis is more likely. Lung cancers rarely present solely with cough. Associated signs and symptoms include weight loss and hemoptysis. Asthma is less likely to present with a productive cough.