A 75-year-old man with a history of hypertension, diabetes, and environmental allergies

Full Answer Section

. Questions Asked as Part of the Medical History:

• Cough Characteristics:
  • When did the cough begin?
  • Is the cough productive (bringing up phlegm) or non-productive (dry)?
  • Is there any sputum (phlegm) production? If so, what color is it?
  • Is the cough worse at any particular time of day or night?
  • Is the cough associated with any other symptoms, such as fever, chills, shortness of breath, chest pain, wheezing, or hoarseness?
  • Any recent travel history?
  • Any exposure to irritants (smoke, fumes, dust)?
• Social History:
  • Smoking history (current or past)?
  • Alcohol use?
  • Occupational exposures?
• Medication History:
  • A complete list of all medications, including over-the-counter and herbal supplements.
  • Any recent medication changes or additions?
  • Any history of medication allergies or side effects?
• Family History:
  • Any family history of lung disease (e.g., COPD, asthma, lung cancer)?

2. Physical Exam Aspects:

• Vital Signs: Blood pressure, pulse, respiratory rate, temperature.
• Cardiovascular System: Auscultation of the heart sounds for murmurs, gallops, or arrhythmias.
• Respiratory System: Auscultation of the lungs for wheezes, rales, rhonchi, or diminished breath sounds.
• Abdomen: Examination for hepatomegaly or splenomegaly.
• Neurological Examination: Assessment of peripheral neuropathy (e.g., vibration sense, light touch).

3. Most Likely Cause:

Given the patient's history of hypertension and the recent initiation of lisinopril, ACE inhibitor-induced cough is the most likely cause of his persistent dry cough. Lisinopril, an ACE inhibitor, is a common medication for hypertension, but a side effect in some patients is a persistent, dry, non-productive cough.  

4. Other Possible Diagnoses:

• Post-nasal drip: Chronic drainage from the sinuses can irritate the back of the throat and cause a cough.  
• Gastroesophageal reflux disease (GERD): Acid reflux can irritate the throat and trigger a cough.  
• Chronic obstructive pulmonary disease (COPD): Although less likely given the lack of significant respiratory symptoms, COPD should be considered in older adults.
• Asthma: While the patient doesn't report wheezing, some patients with asthma may present with a chronic cough.  

5. Other Tests:

• Chest X-ray: To rule out pneumonia, lung cancer, or other lung abnormalities.
• Pulmonary function tests: To assess lung function and rule out COPD or other restrictive lung diseases.
• Sinus imaging: (e.g., CT scan) if post-nasal drip is suspected.

6. Treatment:

• Address the underlying cause:
  • If the cough is indeed due to lisinopril, the physician may consider switching to an alternative antihypertensive medication (e.g., an angiotensin receptor blocker (ARB)).
• Symptomatic relief:
  • If the cough persists despite medication changes, consider adding a low-dose antihistamine or a small dose of a cough suppressant.
• Education:
  • Educate the patient about the potential side effects of lisinopril, including cough.
  • Advise the patient to contact their physician if the cough worsens or if they experience other concerning symptoms.
  • Emphasize the importance of adhering to their medication regimen and maintaining a healthy lifestyle.

Disclaimer: This information is for general knowledge and educational purposes only and does not constitute medical advice.

Disclaimer: This information is for general knowledge and educational purposes only and does not constitute medical advice. The information provided should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any que

Sample Answer

This is for informational purposes only. For medical advice or diagnosis, consult a professional.

Case:

A 75-year-old man with a history of hypertension, diabetes, and environmental allergies 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, and his blood pressure today is 150/92. 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.