Case study of a persistent cough

Case study of a persistent cough
A cough is when air is forced out of the lungs. The patient in the above case study is a thirty-year-old woman who has been coughing for three months. The coughing starts at night and when it’s cold outside. She hasn’t been coughing up blood, losing weight, getting a fever, breathing, or changing her appetite. This story will have more questions that, as her nurse practitioner, I would have asked to figure out what was wrong with her. It will also have an account of how the illness showed up. The cough will be categorized by how long it has been going on, and there will be an alternative diagnosis at some point. Because the signs are similar to those of other diseases, a differential diagnosis is used to figure out what is really wrong.

What else can I ask?

We have been able to figure out some of the history of the cough. With this presentation, a practitioner also tries to find out other information. One would try to find out if the cough is always there or if it comes and goes, or if it bothers the patient all the time. One would also try to find out if the situation gets worse each time it happens or if it doesn’t get worse at all. (Poulose, Tiew, & How.,2016). Also, one would have to find out how often. Is it always at night and in dusty places, or does it sometimes not happen? Again, try to find out how many times these signs happen in a day. I would also try to find out if the talk makes you sweat at night.The different types of coughs

Most of the time, coughing is the body’s normal way of getting rid of things that bother the throat and airways. They are not a medical issue until they start to bother the patient. Coughing can also be a sign of a health problem or an unwanted side effect of some medicines. Coughing for a long time can cause chest pain, broken ribs, loss of bladder control, fatigue, dizziness, and even trouble sleeping.

A cough could be called acute, prolonged, or chronic, depending on how long it lasts. Acute coughs last less than three weeks and are generally caused by a cough or an upper respiratory tract infection like pneumonia, whooping cough, or the flu. Subacute coughs usually last between three and eight weeks and are generally the cough that stays after an illness or infection is gone. (Morice et al., 2020). Chronic coughs last longer than eight weeks and are caused by medical conditions or medicines like Angiotensin-Converting Enzyme Inhibitors. (ACEs). Since this woman’s cough has been going on for three months, it can be called a chronic cough.

A cough can also be labeled as being useful or not. When you cough, mucus comes up from your lungs or sinuses. These can be brought on by a virus, a bacterial infection, smoking, postnasal drip, or stomach acid reflux. On the other hand, the cough that doesn’t do anything doesn’t make any mucus. These can be caused by a virus or germs, bronchospasm, allergies, medications, exposure to irritants, asthma, or a blockage in the airways.

Some diagnostic tests are

No one can agree on the best way to find out what’s wrong with a cough. Several may need to be done, or the problem may be fixed by what works. In the case of these women, we will look at the diagnostic tests that need to be done for a dry and persistent cough, since the cough had been going on for more than eight weeks, according to the woman. Irwin and his partners came up with the rules for diagnosing a chronic cough twenty years ago. Morice et al. (2020) say that their method takes into account the anatomical locations of the receptors that make up the afferent limb of the human cough response. It uses a mix of the patient’s medical history, a physical check, and lab tests that focus on these parts of the body. As there may be more than one reason for a chronic cough, you may need to use more than one treatment.

Chest imaging is one test that can be done. If the results are not normal, the treatment will depend on what the imaging shows. If a lump is found, more tests are done to rule out cancer, such as bronchoscopy, computed tomography, or fine-needle aspiration. The sputum culture is another test that can be done. This is done to find out what kind of organism is causing the cough so that the right medicine can be chosen. If there are signs of an illness, more tests will need to be done to find the microbial organism that caused it. Most people with a prolonged cough are usually healthy. However, they are likely to have upper airway cough syndrome, asthma, gastric reflux disease (GERD), or nonasthmatic eosinophilic bronchitis as the cause of their cough.

There is also the spirometric and peak expiratory flow test that can be done. Irwin, French, and Madison (2020) say that these readings are used to figure out if there is a blockage of airflow. But this method doesn’t seem to be as good as other ways of measuring forced expiratory volume in one second. (FEV1). But this method isn’t used very often in clinics. Also, upper airway stimulation studies are another way to check for a chronic cough. During a standard bronchial challenge test, the maximum inspiratory flow-volume curve is measured. People who had postnasal drips but got better have been seen to have variable extra-thoracic upper airway blockage.

To rule out Gastroesophageal Reflux Disease, tests are also done on the stomach and intestines. A 24-hour pH tracking of the esophagus is done to find out if there is a link between a chronic cough and gastroesophageal reflux disease. (Kahrilas et al., 2016). Even if the pH is not acidic, it can still cause a cough that won’t go away. So, when treating people, both pHs should be taken into account.

Different ways to diagnose a persistent cough (over eight weeks)

FLOWSHEET

condition

Symptoms

Diagnostics

Treatment

Asthma

Bronchial hyperreactivity, wheezing, breathlessness, and trouble breathing are all symptoms.

Spirometry, reversibility of bronchodilators, and the problem of bronchial provocation

Empirical

Use bronchodilators

Antibodies that block leukotriene receptors

Gastroesophageal Reflux Disease (GERD)

Heartburn, trouble swallowing, and a sense of pressure

Swallow evaluation, pH tracking 24 hours a day,

Proton pump inhibitors, changes to food and way of life

Eosinophilic bronchitis not caused by asthma

cough that lasts for more than two years and lasts at least three months each year

Evaluate for sputum eosinophils

Inhaled corticosteroids

Syndrome of the upper airway cough

abnormally high mucus production in the nose

Sinus imaging

Use antihistamines and stuffy-nose medicines.

References

Irwin, R. S., French, C. L., & Madison, J. M. (2020). Managing unexplained chronic cough in adults: what are the unmet needs?. The Lancet Respiratory Medicine, 8(8), 745-747.

Kahrilas, P. J., Altman, K. W., Chang, A. B., Field, S. K., Harding, S. M., Lane, A. P., … & Adams, T. M. (2016). Chronic cough due to gastroesophageal reflux in adults: CHEST guideline and expert panel report. Chest, 150(6), 1341-1360.

Morice, A. H., Millqvist, E., Bieksiene, K., Birring, S. S., Dicpinigaitis, P., Ribas, C. D., … & Rigau, D. (2020). ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. European Respiratory Journal, 55(1).

Poulose, V., Tiew, P. Y., & How, C. H. (2016). Approaching chronic cough. Singapore medical journal, 57(2), 60.

OTHERS:

Related Posts: