Complaint of Persistent Dry Hacking Cough

Cough case study

A 75-year-old man with a history of hypertension, diabetes, environmental allergies, and colon polyps presents to the office with a complaint of persistent dry hacking cough that does not improve with over-the-counter treatment with antitussives and allergy medications. The man reports that he has had the cough for 3 months and is tired of the coughing spells he experiences. His medical history reveals that he started taking lisinopril 6 months before this appointment, has taken an over-the-counter allergy medication for several years, had his last colon polyps removed 6 years ago, and his blood pressure today is 145/70. Other medications include metformin XR 500 mg daily, aspirin 81 mg once daily, and loratadine 10 mg daily. The physical exam is negative for any issues other than his mild neuropathy from long-term diabetes. The cough is noted to be dry and hacking as the patient has described. The man is not in acute distress.

What questions would have been asked as part of the medical history?
What physical aspects would have been completed as part of the physical exam?
Based on the medical history and physical exam, what is the most likely cause of his cough?

The most likely cause of this cough is the Lisinopril medication, that belongs to the angiotensin converting enzymes inhibitor( ACE) inhibitors

What other possible diagnoses should be considered?

Other possible diagnostic are Allergies, Asthma, Common cold, Influenza (Flu), Bronchitis, gastroesophageal reflux disease (GERD), Post nasal drip, Lung cancer.

Are there any other tests that should be completed before producing a diagnosis? Why or why not?
What is the treatment for this patient, including education?

Research: (APA Assignment), Title Page, Introduction, Headings. Citation and reference page is required.

Length: A minimum of 750 words, not including references

Citations: At least two high-level scholarly references in APA from within the last 5 years.

Expectations

APA format with intext citations,

Word count minimum of 750, not including references.

References: at least 2 high-level scholarly references within the last 5 years in APA format.

Plagiarism free.

Turnitin receipt.

Title: A Case Study of Persistent Dry Cough in a 75-Year-Old Man: Evaluating the Role of Lisinopril

Abstract: This case study discusses the evaluation and management of a 75-year-old man with a persistent dry hacking cough. The patient’s medical history includes hypertension, diabetes, environmental allergies, and a recent initiation of lisinopril. The cough has been present for 3 months, unresponsive to over-the-counter treatment, and is causing discomfort. This paper explores the medical history, physical examination findings, differential diagnoses, and diagnostic tests to identify the most likely cause of the cough. The study concludes with a treatment plan and patient education to improve the patient’s quality of life.

Introduction: Persistent coughing is a common medical problem, often resulting from various etiologies. Proper evaluation and accurate diagnosis are essential for providing effective treatment. This case study focuses on a 75-year-old man with a dry hacking cough that has persisted for 3 months. The patient’s medical history includes hypertension, diabetes, environmental allergies, and recent initiation of lisinopril, an angiotensin-converting enzyme (ACE) inhibitor. The aim is to explore potential causes and devise an appropriate treatment plan.

Medical History Questions: As part of the medical history, the following questions would be asked:

How long have you had the cough?
Can you describe the characteristics of the cough (dry, productive, worsening at night)?
Have you experienced any triggers for the cough, such as exposure to specific allergens or cold air?
Do you have a history of allergies or asthma?
Are you experiencing any other symptoms, such as shortness of breath, wheezing, or chest pain?
Have you started any new medications recently?
Have you made any changes in your environment or household products recently?
Is there a history of respiratory illnesses or lung conditions in your family?
Have you traveled or been exposed to any infectious agents recently?
Have you noticed any association between the cough and your diabetes or hypertension medications?

Physical Examination Aspects: The physical examination would focus on the respiratory system and general health assessment, including:

Inspection of the chest and respiratory rate
Listening to breath sounds (e.g., wheezing, crackles, decreased air entry)
Checking for signs of respiratory distress
Examination of the throat and nasal passages for signs of postnasal drip
Checking for signs of gastroesophageal reflux disease (GERD), such as heartburn or regurgitation
Assessing for any signs of lung cancer (e.g., weight loss, fatigue, clubbing of fingers)

Most Likely Cause: Considering the patient’s medical history, recent initiation of lisinopril, and absence of other significant findings on physical examination, the most likely cause of his cough is the medication, lisinopril. ACE inhibitors are known to cause a dry, persistent cough in some patients. This side effect occurs due to the accumulation of bradykinin and substance P, leading to irritation of the respiratory tract.
Other Possible Diagnoses: While lisinopril-induced cough is the most likely cause, other possible diagnoses that should be considered include:

Allergies: Environmental allergens may trigger coughing spells in susceptible individuals.
Asthma: Chronic inflammation of the airways can lead to persistent cough.
Common cold or Influenza (Flu): Respiratory infections can cause a lingering cough.
Bronchitis: Inflammation of the bronchial tubes can lead to a prolonged cough.
GERD: Acid reflux can irritate the throat and cause coughing.
Postnasal drip: Excessive mucus dripping down the back of the throat can cause coughing.
Lung cancer: Though less likely, it is crucial to rule out malignancy, especially in older adults.

Additional Tests: Before confirming the diagnosis, additional tests may be required to rule out other potential causes and evaluate the extent of the patient’s condition. These tests may include:

Chest X-ray: To check for any abnormalities in the lungs or airways.
Spirometry: To assess lung function and rule out asthma.
Allergy testing: To identify specific allergens triggering the cough.
Gastrointestinal evaluation: To rule out GERD and assess for any esophageal disorders.
Sputum culture: To check for signs of infection.

Treatment and Education: Considering that lisinopril is the most likely cause of the persistent cough, the treatment plan involves discontinuing lisinopril and switching to an alternative antihypertensive medication. The patient should be educated about the potential side effects of ACE inhibitors and informed about the importance of adhering to prescribed medications.

For symptomatic relief of the cough, the patient can be prescribed cough suppressants or bronchodilators if bronchospasm is suspected. Allergy management may also be recommended, including avoidance of allergens and use of antihistamines if allergies are contributing to the cough.

Patient education should also include lifestyle modifications such as avoiding triggers, staying hydrated, and practicing good respiratory hygiene. The patient should be advised to seek medical attention if symptoms worsen or if any new concerning symptoms develop.

Conclusion: The case study of the 75-year-old man with a persistent dry hacking cough highlights the importance of a comprehensive medical history, physical examination, and diagnostic evaluation to arrive at an accurate diagnosis. Considering the patient’s medical history and recent initiation of lisinopril, the most likely cause of the cough is medication-induced irritation. By discontinuing lisinopril and implementing an appropriate treatment plan, the patient’s quality of life can be significantly improved. Patient education is essential to manage symptoms effectively and prevent complications.