Cough Case Studies
Thank you very much for referring Robert along for his four-month history of productive cough. As you are aware, he does not believe that it was a significant infection that started this all off, but did note some fevers and sweats at the time. He has noticed a productive cough of about 10ml of green sputum, predominantly in the morning. Unfortunately, this has not responded to antibiotics including both typical and atypical cover. He does have some sinus nasal stuffiness with post-nasal drip and he did trial some Nasonex for three does but stopped this as he did not feel that it was of significant benefit. The productive is not associated with any shortness of breath or wheeze and he no longer notices any fevers, sweats or loss of weight.
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He works as a building designer, without any significant occupational exposures and only has a spoodle at home. He did grow up on a farm.
His only significant chest complaint in the past was a pneumonia, seven years ago, for which he was on IV antibiotics, but he recovered from this well.
His brother passed away recently, at the age of 48, and Robert believes that he may have had pulmonary fibrosis. His other significant family history is that of his father passing away in his 50s from melanoma.
On examination, he was not clubbed, he was saturating at 99% on room air and his lung fields revealed some crackles in the left base but no significant wheeze.
Cardiovascular examination did not reveal any significant cardiac failure.
Thank you for organising a CT scan of the sinus and chest. There was some sinus disease seen and also some patchy changes in the left lung base with some scarring in the area. There were no other significant abnormalities seen.
Impression/Management:
The productive nature of the cough with this sinus disease does make post-nasal drip the most likely contributor here. Given this, I have suggested the we restart on Nasonex, alongside some saline sinus rinse and I have asked him to trial this for a good three weeks. The significance of the left lower lobe changes are uncertain and may represent resolving infection, or indeed residual scar tissue from a chest infection in the past. As a precaution, though, I have organised three sputum samples, where will test for atypical microbes. I will organise some baseline blood tests, looking for some Aspergillus sensitivity and also any immunodeficiency. I will then see Robert in three or four weeks' time to hopefully assess for resolution of the previous sinus and lung changes, and some lubg funtion
tests.
He works as a building designer, without any significant occupational exposures and only has a spoodle at home. He did grow up on a farm.
His only significant chest complaint in the past was a pneumonia, seven years ago, for which he was on IV antibiotics, but he recovered from this well.
His brother passed away recently, at the age of 48, and Robert believes that he may have had pulmonary fibrosis. His other significant family history is that of his father passing away in his 50s from melanoma.
On examination, he was not clubbed, he was saturating at 99% on room air and his lung fields revealed some crackles in the left base but no significant wheeze.
Cardiovascular examination did not reveal any significant cardiac failure.
Thank you for organising a CT scan of the sinus and chest. There was some sinus disease seen and also some patchy changes in the left lung base with some scarring in the area. There were no other significant abnormalities seen.
Impression/Management:
The productive nature of the cough with this sinus disease does make post-nasal drip the most likely contributor here. Given this, I have suggested the we restart on Nasonex, alongside some saline sinus rinse and I have asked him to trial this for a good three weeks. The significance of the left lower lobe changes are uncertain and may represent resolving infection, or indeed residual scar tissue from a chest infection in the past. As a precaution, though, I have organised three sputum samples, where will test for atypical microbes. I will organise some baseline blood tests, looking for some Aspergillus sensitivity and also any immunodeficiency. I will then see Robert in three or four weeks' time to hopefully assess for resolution of the previous sinus and lung changes, and some lubg funtion
tests.