A 75-year-old man with a history of hypertension, diabetes, environmental allergies, and colon polyps presents to the office with a complaint of persistent dry hacking cough that does not improve with over-the-counter treatment with antitussives and allergy medications. The man reports that he has had the cough for three months and is tired of the coughing spells he experiences. His medical history reveals that he started taking lisinopril six months before this appointment, has taken an over-the-counter allergy medication for several years, had his last colon polyps removed six years ago, and his blood pressure today is 145/70. Other medications include metformin XR 500 mg daily, aspirin 81 mg once daily, and loratadine 10 mg daily. The physical exam is negative for any issues other than his mild neuropathy from long-term diabetes. The cough is noted to be dry and hacking as the patient has described. The man is not in acute distress.
Case Questions:
Using OLDCARTS, what questions would have been asked as part of the medical history?
What physical aspects would have been completed as part of the physical exam and why? Include the diagnostics that you would order and rationale.
Based on the medical history and physical exam, what is the most likely cause of his cough?
What other possible diagnoses should be considered and why?
Are there any other tests that should be completed before producing a diagnosis? Why or why not?
What is the treatment for this patient, including education?