Cough Case Study
Cough
Heather Colome
University of South Florida
Cough
CASE ONE: Mrs. L. Windermere is a 73-year-old woman under your care for more than a decade. She has no chronic medical conditions and comes in once a year in the spring just to “catch up.” In this visit her only complaint is a cough. It started a month or two ago following a cold. She hadn’t been very ill – just some congestion and rhinorrhea. After those symptoms mostly resolved, she developed this cough. She asks, “Is there something you can give me for this cough?”
1. How is cough categorized? Is this a chronic cough?
According to Pratter, Brightling, Boulet, and Irwin, (2006), based on duration, cough can be divided into three categories: acute, lasting < 3 weeks; subacute, lasting between 3 and 8 weeks; and chronic, lasting > 8 weeks. Pratter et al. (2006) stated the “gold standard” for assessing the accuracy of diagnosis and the effectiveness of the physician’s management of a patient’s cough is the response to specific treatment. Pratter et al. (2006) found with acute cough the most important first step is to decide whether the acute cough is potentially life threatening (Pneumonia, Severe Exacerbation of Chronic obstructive pulmonary disorder (COPD), Pulmonary embolism (PE), or Heart Failure) or not (Upper respiratory infection (URI), Lower respiratory infection (LRI), Asthma, Bronchiectasis, Upper Airway Cough Syndrome (UACS), and COPD). Pratter et al. (2006) found that in managing patients with subacute cough the first step is to determine whether or not the cough has followed an obvious preceding respiratory infection. According to Pratter et al. (2006), if the subacute cough does not appear to be infectious in nature, it should be evaluated and managed as if it were a chronic cough however subacute cough frequently starts with an acute upper respiratory tract infection and lingers on typically falling into the category of postinfectious cough. Pratter et al. (2006) found that
Heather Colome
University of South Florida
Cough
CASE ONE: Mrs. L. Windermere is a 73-year-old woman under your care for more than a decade. She has no chronic medical conditions and comes in once a year in the spring just to “catch up.” In this visit her only complaint is a cough. It started a month or two ago following a cold. She hadn’t been very ill – just some congestion and rhinorrhea. After those symptoms mostly resolved, she developed this cough. She asks, “Is there something you can give me for this cough?”
1. How is cough categorized? Is this a chronic cough?
According to Pratter, Brightling, Boulet, and Irwin, (2006), based on duration, cough can be divided into three categories: acute, lasting < 3 weeks; subacute, lasting between 3 and 8 weeks; and chronic, lasting > 8 weeks. Pratter et al. (2006) stated the “gold standard” for assessing the accuracy of diagnosis and the effectiveness of the physician’s management of a patient’s cough is the response to specific treatment. Pratter et al. (2006) found with acute cough the most important first step is to decide whether the acute cough is potentially life threatening (Pneumonia, Severe Exacerbation of Chronic obstructive pulmonary disorder (COPD), Pulmonary embolism (PE), or Heart Failure) or not (Upper respiratory infection (URI), Lower respiratory infection (LRI), Asthma, Bronchiectasis, Upper Airway Cough Syndrome (UACS), and COPD). Pratter et al. (2006) found that in managing patients with subacute cough the first step is to determine whether or not the cough has followed an obvious preceding respiratory infection. According to Pratter et al. (2006), if the subacute cough does not appear to be infectious in nature, it should be evaluated and managed as if it were a chronic cough however subacute cough frequently starts with an acute upper respiratory tract infection and lingers on typically falling into the category of postinfectious cough. Pratter et al. (2006) found that
References: Bhatt SP, Nanda S, and Kintzer JS. The Lady Windermere Syndrome: Primary Care Respiratory Journal (2009); 18(4): 334-336. http://doi:10.4104/pcrj.2009.00019 Pratter MR, Brightling CE, Boulet LP, and Irwin RS. An Empiric Integrative Approach to the Management of Cough: ACCP Evidence-Based Clinical Practice Guidelines. Chest 2006, 129(1_suppl):222S-231S. http://journal.publications.chestnet.org/data/Journals/CHEST/22039/222S.pdf Tofts RP, Olivera E, and Ferrer G. Investigate a chronic cough: Cleveland Clinic center for Continuing Education (2011); 78(2): 84-89. http://www.clevelandclinicmeded.com/medicalpubs/ccjm/investigating-chronic-cough-2-2011/