Correct!
5. All of the above
Chronic cough is a very common reason for patients to seek consultation from a pulmonary physician. The most common causes are asthma, gastroesophageal reflux disease (GERD), and upper airway cough syndrome (UACS) secondary to rhinosinus diseases (postnasal drip) (1). She had a chest x-ray (Figure 1) which was interpreted as showing no acute disease.
Figure 1. Initial chest radiography.
Spirometry done was interpreted as normal with an FVC of 87% predicted and an FEV1 of 95% predicted. In this patient’s case she had nothing to suggest a source of her cough other than the bilateral nasal congestion. She was therefore treated with triamcinolone nasal spray.
Her cough persisted but in the interim she moved from Chicago to the Phoenix area. Starting on May 12, 2020, she developed fever up to 102° F with the cough persisting.
Her physical examination showed only decreased breath sounds at the right base. A review of her medications indicated she was taking lisinopril, amlodipine, albuterol prn, triamcinolone nasal spray and codeine/guaifenesin for cough.
What should be done at this time? (Click on the correct answer to be directed to the third of seven pages)