“A 60 year old man that enters your community pharmacy and asks to speak to you about his cough which he has had for more than three weeks”
A cough is a troublesome symptom that is frequently presented to clinicians in both primary and secondary care. A cough is caused by a reflex that occurs by an irritation of the respiratory mucosa in the lungs, bronchi and pharynx. It allows for the removal of foreign particles and secretions from the respiratory system (Irwin & Madison, 2000). A cough can be classified according to it’s duration, a cough of threes weeks is acute, and a cough that lasts longer than 8 weeks is classified as chronic. If it is in between the period of 3-8 weeks is known to be subacute (Pratter, Brightling, Boulet, & Irwin, 2006). This essay will look at the case of a 60 year old man who presents to us a symptom of a persistent cough lasting longer than 3 weeks. An attempt to diagnose the patients will be made by assessing the cough through different guidelines available.
The first question a clinician shall ask when diagnosing a patient with a cough is about the duration. This patient is an elderly man, with a cough of three weeks, thus classified as a subacute cough. The main diagnostic distinction to make for a patient presenting with a subacute cough, is to identify whether the cough has been caused by an infection. However, due to this man being an elderly man, one must immediately find out the patient’s drug history, as to see if any ACE inhibitors have been prescribed. This is due to the reason that ACE inhibitors are known to cause a dry persistent cough to around 10% of patients treated with it. (Longmore, Wilkinson, & Rajagopalan, 2004). If the patient is not on any medications that can cause the co...
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...0). The diagnosis and treatment of cough. New England Journal of Medicine, 343, 1715–1721.
• Jevon, P. (2011). Clinical diagnosis. Chichester, West Sussex: Wiley-Blackwell.
• Kumar, P. J. (2012). Kumar & Clark's clinical medicine (8th ed.). Edinburgh: Elsevier/Saunders.
• Longmore, J. M., Wilkinson, I., & Rajagopalan, S. R. (2004). Oxford handbook of clinical medicine (6th ed.). Oxford: Oxford University Press.
• National Institute for Health and Care Excellence (2008). Respiratory tract infections – Antibiotic Prescribing. CG069. London: National Institute for Health and Care Excellence.
• Pratter, M. R., Brightling, C. E., Boulet, L. P., & Irwin, R. S. (2006). An Empiric Integrative Approach to the Management of Cough: ACCP Evidence-Based Clinical Practice Guidelines. Chest Journal, 129(1), 222-231. Retrieved October 24, 2013, from http://tinyurl.com/mthq2gk