Question

59 yo F is evaluated for an 8 month hx of minimally productive cough. Her cough has persisted despite empiric treatment with intranasal and inhaled glucorticoids.Most appropriate management?

Answer 1

For a 59-year-old female with a persistent cough unresponsive to glucocorticoids, appropriate management involves further evaluation to identify and treat the underlying cause—potentially COPD, pneumonia, GERD, or postnasal drip. Diagnostic tests such as chest radiography, spirometry, and possibly a CT scan or bronchoscopy may be necessary.

Step-by-step explanation:

The most appropriate management for a 59-year-old female with an 8-month history of minimally productive cough, persistent despite treatment with intranasal and inhaled glucocorticoids, would require further evaluation. Considering the duration of the cough and the lack of response to treatment, the possibility of underlying conditions such as asthma, chronic obstructive pulmonary disease (COPD), or pneumonia should be investigated. These possibilities can be differentiated with a detailed medical history, physical examination, chest radiography, and even spirometry to assess lung function. Additionally, evaluating for gastroesophageal reflux disease (GERD) or postnasal drip as possible causes of chronic cough should also be considered. If these assessments still do not provide a diagnosis, referral to a pulmonologist for further investigation would be appropriate. Furthermore, other diagnostic tests like CT scans, bronchoscopy, or testing for specific infections may be necessary based on clinical judgment and the patient's medical history.