BOF: 11
A 27-year-old female presents with a history of chronic
cough. It is a dry cough that occurs mainly at night and is also related to
exertion coming on when she goes jogging
There is no fever, no history of headaches, stuffy nose
or postnasal drip. Review of systems does not elicit any further symptoms. She
gives a history of bronchitis as a child. Her brother has eczema.
She does not smoke or drink and is not taking any
medications.
She works as a secretary in a legal firm. She is
unmarried.
On examination no abnormalities are detected. Routine
haematology and biochemistry are within normal limits.
Lung function tests show:
FEV1 4.0 (3.6-4.2 predicted)
FVC 5.2 (4.5-5.4 predicted)
PEFR 470 (440-540)
In this patient which of the
following tests would you arrange to ascertain the diagnosis?
a) Lateral
chest x-ray
b) CT scan of
chest
c) Exercise
test
d) OGD
e) CT
paranasal sinuses
Answer: c)
Cough may be due to a number of
conditions
In a patient with a dry cough
and no abnormalities detected on examination and routine investigation, one
should consider bronchial asthma, gastro-oesophageal reflux disease and
chronic sinusitis.
In this patient with a history
of bronchitis in childhood (may have been undiagnosed asthma) and possible
atopy (family history of eczema) the test most likely to give a diagnosis
would be the exercise test – peak flow in response to exercise. A reduction in
peak flow in response to exercise would indicate bronchial asthma
Revision Tip
Revise causes of cough
ACES for PACES page 246
Revise asthma
KEYS to SUCCESS in Medicine page182-185
