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Zorluk: OrtaGeneral Internal Medicine

Match each patient's clinical presentation of chronic cough with the most appropriate initial pharmacological intervention or management step.

  • A 45-year-old man presents with an 8-week history of cough, predominantly at night, associated with frequent throat clearing and a sour taste in his mouth.Empirical trial of a proton pump inhibitor
  • A 35-year-old woman presents with a 10-week history of dry cough, accompanied by a sensation of liquid dripping down the back of her throat and cobblestoning of the posterior pharynx.Empirical trial of an oral first-generation antihistamine-decongestant
  • A 28-year-old man presents with a 3-month history of a nonproductive cough that worsens with exercise and cold air exposure; lung examination is unremarkable.Initiation of an inhaled corticosteroid
  • A 62-year-old woman presents with a 6-month history of dry cough; her medical history is notable for hypertension treated with lisinopril and hydrochlorothiazide.Discontinuation of the angiotensin-converting enzyme inhibitor

Cevap

The correct matches pair GERD with a proton pump inhibitor, upper airway cough syndrome with a first-generation antihistamine-decongestant, cough-variant asthma with an inhaled corticosteroid, and ACE inhibitor-induced cough with medication discontinuation.
Chronic cough is defined as a cough lasting longer than 8 weeks. The most common causes are upper airway cough syndrome (UACS), asthma, gastroesophageal reflux disease (GERD), and medications (specifically ACE inhibitors). Patient 1 has typical GERD symptoms, making a proton pump inhibitor the best next step. Patient 2 describes UACS, which responds to a first-generation antihistamine-decongestant. Patient 3 has cough-variant asthma, appropriately managed with inhaled corticosteroids. Patient 4 is on an ACE inhibitor, which must be discontinued to determine if the cough resolves.

Adım Adım Çözüm

1
Analyze each clinical vignette to identify the underlying etiology of the chronic cough.
Patient 1 has GERD, Patient 2 has upper airway cough syndrome, Patient 3 has cough-variant asthma, and Patient 4 has an ACE inhibitor-induced cough.
Identifying the distinct clinical pattern is required before selecting the appropriate empirical therapy.
2
Select the guideline-recommended first-line management for each identified etiology.
GERD requires a PPI; upper airway cough syndrome requires an antihistamine-decongestant; asthma requires inhaled corticosteroids; ACE inhibitor cough requires stopping the drug.
Standard of care dictates specific targeted empirical trials for the most common causes of chronic cough when the chest radiograph is presumed normal.

Anahtar Kavram

The evaluation and empirical management of chronic cough (lasting >8 weeks) in adults involves targeting the four most common etiologies: upper airway cough syndrome, asthma, gastroesophageal reflux disease, and ACE inhibitor use.
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General Internal Medicine

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