Chronic cough and complexity
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Cases and topics
A patient presented for a follow-up appointment to discuss the outcomes of a recent chest X-ray. The patient's cough onset coincided with a significant public holiday on November 14th. Despite the X-ray results indicating no abnormalities, the patient's cough persisted even after completing a course of antibiotics.
Three weeks prior, the patient was prescribed Ciprofloxacin, which led to a temporary improvement in symptoms. No signs of hemoptysis or weight loss were reported during this visit. It was noted in the patient's medical history that there was a period of weight loss in the previous year, prompting a referral to a specialist clinic for an extensive evaluation, including CT scans of the abdomen, pelvis, and chest, all of which returned normal results. The patient mentioned recovery post-surgery and had been under the care of the mental health team, showing improvement in depressive symptoms.
A thorough review of the patient's medical history revealed chronic conditions including diabetes, chronic kidney disease, depression, claustrophobia, biliary tract disorder, and lumbar spine degeneration. The patient's medication history indicated no use of immunosuppressants or ACE inhibitors.
During the consultation, the patient inquired about their medication regimen, specifically chronic pain management which had been previously discussed with another doctor. The patient had been on a long-term regimen of dihydrocodeine and morphine patches. Recent adjustments had successfully halved the patient's dihydrocodeine intake from 224 to 112 tablets per month. The patient was praised for this achievement, and further reduction was suggested to address concerns regarding tolerance and potential addiction, alongside the risks associated with prolonged codeine use, including immunosuppression.
A comprehensive medication review was conducted, addressing compliance, side effects, and indications for each medication. This included Prucalopride, recently prescribed for diarrhea, the rationale for which required clarification due to forgotten details.
The consultation also explored the patient's chronic pain, primarily attributed to lumbar disc degeneration diagnosed in 1990. Considering the persistent cough, differential diagnoses such as COPD, asthma, or a post-infectious cough were considered. The exact duration of a post-infectious cough remained uncertain.
The plan included prescribing Salbutamol and arranging spirometry testing for a more definitive diagnosis, aiming to refine the patient's treatment plan based on these results.