MEDizzy - A 42-year-old woman seeks evaluation for a cough that has

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Introduction to clinical medicine

A 42-year-old woman seeks evaluation for a cough that has been present for almost 3 months. The cough is mostly dry and non-productive, but occasionally productive of yellow phlegm. She reports that the cough is worse at night and often wakes her from sleep. She denies any recent upper respiratory tract infection, allergic rhinitis, fever, chills or cough. She recalls her mother told her that she had asthma as a child but she has never felt symptomatic wheezing as an adult. She exercises regularly but continues to smoke 1 pack per day of cigarettes; she’d like to quit. The patient takes no medications. Her physical examination is unremarkable. Which of the following is indicated at this point?

ExplanationChronic cough should not be diagnosed until consistently present for over 2 months. The duration of cough is a clue to its etiology. Acute cough (<3 weeks) is most commonly due to a respiratory tract infection, aspiration event, or inhalation of noxious chemicals or smoke. Subacute cough (3–8 weeks duration) is fre - quently the residuum from a tracheobronchitis, such as in pertussis or “post-viral tussive syndrome.” Chronic cough (>8 weeks) may be caused by a wide variety of cardiopul - monary diseases, including those of inflammatory, infectious, neoplastic, and cardio - vascular etiologies. In virtually all instances, evaluation of chronic cough merits a chest radiograph. The list of diseases that can cause persistent coughing without other symp - toms and without detectable abnormality on physical examination is long. It includes serious illnesses such as Hodgkin’s disease in young adults and lung cancer in an older population. An abnormal chest film leads to evaluation of the radiographic abnormality to explain the symptom of cough. A normal chest image provides valuable reassurance to the patient and the patient’s family, who may have imagined the direst explanation for the cough. Chest PET-CT is often helpful in evaluation of solitary pulmonary nodules or suspected malignancy. Sinus CT should not be utilized in the initial evaluation of chronic cough without strong historical or physical examination of sinus disease or infection. While ACE-inhibitor medications are a common cause of chronic cough, measurement of ACE levels is not helpful clinically. Measurement of serum IgE may be a component of the comprehensive evaluation of patients with refractory asthma or suspected allergic bronchopulmonary aspergillosis. It is not helpful in the initial evaluation of cough in a patient without allergic history