Case Study A 75-year-old man with a

Case Study A 75-year-old man with a…

Patient:

Name: John Smith
Age: 75
Gender: Male
Race: White
Occupation: Retired
Medical history: Hypertension, diabetes, environmental allergies, colon polyps
Medications: Lisinopril, metformin XR, aspirin, loratadine

Chief complaint:

Persistent dry hacking cough that does not improve with over-the-counter treatment

History of present illness:

The patient is a 75-year-old man with a history of hypertension, diabetes, environmental allergies, and colon polyps who presents to the office with a complaint of a persistent dry hacking cough that has been present for 3 months. The cough is worse at night and does not improve with over-the-counter treatment with antitussives and allergy medications. The patient denies any other symptoms, such as fever, shortness of breath, or chest pain.

Past medical history:

Hypertension
Diabetes
Environmental allergies
Colon polyps

Social history:

The patient is retired and lives with his wife.
He is a former smoker, but he quit smoking 20 years ago.
He drinks alcohol socially.
He does not use any illicit drugs.

Physical examination:

The patient is a well-developed, well-nourished male in no acute distress.
His vital signs are as follows:
Temperature: 98.6°F
Blood pressure: 145/70 mmHg
Pulse: 80 beats per minute
Respirations: 16 breaths per minute
Oxygen saturation: 98% on room air
The patient’s head, eyes, ears, nose, and throat are unremarkable.
His neck is supple without lymphadenopathy.
His lungs are clear to auscultation bilaterally.
His heart is tachycardic but regular.
His abdomen is soft, non-tender, and non-distended.
His extremities are warm and well-perfused.

Laboratory studies:

White blood cell count: 12,000 cells/µL
Hemoglobin: 14 g/dL
Hematocrit: 42%
Platelet count: 250,000 cells/µL
Sodium: 140 mEq/L
Potassium: 4.0 mEq/L
Chloride: 100 mEq/L
Bicarbonate: 24 mEq/L
Blood urea nitrogen: 15 mg/dL
Creatinine: 1.0 mg/dL
Glucose: 100 mg/dL
Chest X-ray: Normal

Diagnosis:

ACE inhibitor-induced cough

Treatment plan:

Discontinue lisinopril.
Start a different class of medication to treat hypertension.
Use over-the-counter cough suppressants and expectorants.
Drink plenty of fluids.
Avoid smoking and secondhand smoke.

Prognosis:

The patient’s prognosis is good with appropriate treatment. The cough should resolve within a few weeks of discontinuing the ACE inhibitor.