A patient comes in to see you complaining of a cough for three months. How does your assessment of this cough differ from a patient who has had a cough for five days?
The mean time that a cough is expected to last is about 18 days according to a 2013 research by Mark Ebell MD et al., posted in the Annals of Family Medicine website. Basing my assessment from this report, I am certain that cough that lasts for over the mean 18 days (about 3 weeks) qualifies as a chronic cough. Alana Biggers MD (2018), writes in Medical News Today that any cough lasting longer than 8 weeks and 4 weeks in adults and children respectively calls for an alarm and immediate serious medical attention. Ebell and Biggers both confirm that such persistence for a cough may be a sign of lung or heart diseases like asthma or in other cases, bronchitis or gastroesophageal reflux disease (GERD). For a patient who has had a cough lasting five days, I may assume that the causes maybe allergic reactions or cold and flu, or other viral infections.
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What are the potential red flags?
The first potential flag for this persistent cough is the duration. As affirmed, any cough lasting above four weeks in adults and children is dangerous. Other red flags include wheezing, past histories of chest infections, spitting phlegm for times exceeding three months, late night incessant coughing, excessive use of antibacterial medication for other treatments and coughing up blood (Haemoptysis), difficulty in breathing (dyspnoea) and pleuritic pains ( Matthys and Heger, 2017) .
What is important not to miss in your review of systems?
When conducting the review of the patient’s systems, the most important things not to miss are: skin conditions, cardiovascular state, respiratory health, gastrointestinal urinary, neurologic and musculoskeletal question. This question helps in creating the history of the patient’s illness (HPI) ( Matthys & Heger, 2017) . In this case, the HPI would consist of questions on: history of chest problems and coughing, the history of medication that the patient has been taking, the current condition, any allergic responses, family medical history, their history of social habits and many other aspects of their health
What are the differential diagnosis for a cough lasting three months?
The conduction of the differential diagnoses begins with the consideration of duration of the cough. As already established, the cough can be acute cough if it last for less than 4 weeks. Otherwise, if the cough has lasted between 3 and 8 weeks, then it is a sub-acute cough. Chronic coughs are those that have persisted after the 8 weeks benchmark. In this particular case, the cough has lasted for over 8 weeks (12 months). It is therefore a chronic cough as identified by Biggers (2018) in the causes and symptoms of cough.
What are the top three causes of a cough lasting three months?
The top three causes of chronic coughs are GERD, the postnasal drip syndrome and nonasthmatic eosinophilic bronchitis (NAEB). These causes can be determined clinically ( Ebell, et al., 2013).
A sample HPI for the above patient
Sample HPI
Patient ID
Name: John Doe
Occupation: Driver
Address: 1234-5673
Date (of admission): 29-01-2020
Medical History
Current Condition (CC)
Constant cough, chest pains, nocturnal coughs, phlegm and haemoptysis and dyspnea
General body weakness and difficulty breathing
Past Medical History (PMH)
No recorded medical problems
No allergies
Immunizations done at appropriate ages
Family History (FH)
No family illness history
Medications History (MH)
No medication history
Social History Habits (SHH)
No tobacco smoking
No alcohol consumption
No narcotics use
Data of Physical Examination
Satisfactory body Temperature: T=36.7 0 C
Consciousness is clear
No reported pains on any body parts except chest
Systems Analysis
Respiratory System
Laboured nasal breathing
Bulged Chest shape
Deformed Chest
Repiratorty patterns irregular
Poor purcusion of lungs
Adventitious sounds heard for lung auscultation
Cardiovascular System
No observable abnormality
Gastrointestinal tract
No observable abnormality
Urinary System
No observable abnormality
Provisional Diagnosis
Bronchitis
Investigation Data
Blood Analysis
Urine Analysis
Biochemical Analysis
Treatment
Aspirin
Ibuprofen
References
Biggers, A. (2018). Chronic Cough: Causes, symptoms, and treatment. Retrieved 29 January 2020, from https://www.medicalnewstoday.com/articles/321597.php
Ebell, M., Lundgren, J., & Youngpairoj, S. (2013). How Long Does a Cough Last? Comparing Patients' Expectations With Data From a Systematic Review of the Literature. The Annals Of Family Medicine , 11 (1), 5-13. doi: 10.1370/afm.1430
Matthys, H., & Heger, M. (2017). Treatment of acute bronchitis with a liquid herbal drug preparation from Pelargonium sidoides (EPs 7630): a randomised, double-blind, placebo-controlled, multicentre study. Current Medical Research And Opinion , 23 (2), 323-331. doi: 10.1185/030079906x167318
