Chronic Cough And Reflux : Is Esophageal Motility The Key?

According to the provider, the claimant's cough has been improved. His review of systems was positive for fatigue, malaise, sleep difficulty, shortness of breath, wheezes, and a cough. His blood pressure was 115/71 mmHg and his BMI was 30.35 kg/m2. The physical examination revealed wheezes. Clonazepam was prescribed for agitation. Atorvastatin, Nystatin, Citalopram, and a probiotic were prescribed. Continued use of Aspirin and a regular inhaler were suggested. Further, a follow-up visit with Endocrinology, Cardiology, and Pulmonology. As it relates to a spot in his lung, a repeat CT scan was recommended. The bronchial washes were negative for

History of Present Illness: Ms. Manock is a very pleasant 60-year-old woman with a history of severe COPD. She was previously seen by Elvira Aguila, MD. Her last office visit was in February 2015. Since that time, she states that over the last few weeks, she feels her dyspnea has worsened which is a result of increased humidity, which is normal for her. She has had a stable cough over the last six months, which is intermittently productive of sputum. She is using her supplemental oxygen at 2 L/minute with exertion and with sleep. She also notes postnasal drip, which is related to seasonal allergies.

Health, N. I. (2013, April 17). U.S. National Library of Medicine. Retrieved from http://www.bradenscale.com/: https://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/LNC_BRADEN/

History of Present Illness: Ms. Crouthamel is a very pleasant 76-year-old woman who I saw in April for a COPD and hypoxic respiratory failure. She has had stable symptoms of shortness of breath. She denies any significant cough. She does state that the humid weather can make breathing difficult at times. She remains active by participating in work in her garden on a daily basis. She is on supplemental oxygen 24 hours a day. She does also admit to occasional tobacco use.

History of Present Illness: Mr. Olson is a very pleasant 57-year-old gentleman with multiple medical problems to include severe COPD, who is here today for an initial consultation for his shortness of breath. He is followed by a pulmonologist Dr. William Goodman, at the Veteran Affairs Administration. His last evaluation there was in February 2015. Mr. Olson states he has had ongoing dyspnea on exertion over the last two years. He complains of minimal cough. He does note some sinus problems for which he is on Flovent. In the past, he has had pulmonary function testing that did demonstrate reversible airflow obstruction, therefore he likely has some component of asthma overlay. He states that occasionally has chest tightness and chest heaviness. He has gained about 25 pounds over the last year. He is currently using Spiriva, albuterol as needed as well as Symbicort. He is also using supplemental oxygen at 2.5L per minute at night as well as on an as needed basis during the day. Mr. Olson admits to continued tobacco use with about a half pack to a pack a day. He states that when he is feeling depressed, he will smoke more.

MIMS (Vol. 47). (E. Donohoo, Ed.) St. Leonards, NSW, Australia: UBM Medica Australia Pty Limited. MIMS Australia. (2014).

National Library of Medicine. National Institutes of Health, 14 Mar. 2017. Web. 17 Mar. 2017.

The information collected in the history was highly suggestive of COPD. One of the best predictors of airflow obstruction was the patient’s smoking history (Qaseem, et al., 2011, pp. 181). According to Qaseem, et al. (2011), the presence of the patient’s smoking history and wheezing on physical examination is indicative of airflow obstruction (pp. 181). Additionally, the patient’s presenting complaint was dyspnea on exertion, which is one of the most commonly presenting complaints in patients with COPD (Boardman, 2013, pp. 446). The chronic nature of the patient’s cough and slow progression of symptoms are consistent with a diagnosis of COPD rather than asthma. Finally, the diminished breath sounds on auscultation is indicative of airflow obstruction and considered to be a reliable finding in the diagnosis of COPD (Boardman, 2013, pp. 447). In addition to the new diagnosis of COPD, the patient also had current diagnoses of hypertension, hyperlipidemia, and osteoarthritis.

The World Health Organization (WHO) (2006A) defines COPD as a disease state characterized by airflow limitation that is not wholly reversible. The airflow limitation is usually both progressive and associated with abnormal inflammatory response of the lungs to noxious particles or gases. John's chronic bronchitis is defined, clinically, as the presence of a chronic productive cough for 3 months in each of 2 successive years, provided other causes of chronic cough have been ruled out. (Mannino, 2003). The British lung Foundation (BLF) (2005) announces that chronic bronchitis is the inflammation and eventual scarring of the lining of the bronchial tubes which is the explanation for John's dyspnea. The BLF (2005) believe that when the bronchi become inflamed less air is able to flow to and from the lungs and once the bronchial tubes have been irritated over a long period of time, excessive mucus is produced. This increased sputum results from an increase in the size and number of goblet cells (Jeffery, 2001) resulting in John's excessive mucus production. The lining of the bronchial tubes becomes thickened and an irritating cough develops, (Waugh & Grant 2004) which is an additional symptoms that john is experiencing.

An ongoing cough or a cough that produces large amounts of mucus (often called "smoker's cough")

Authors: Lawrence Robinson, Melinda Smith, M.A., Jeanne Segal, Ph.D., and Damon Ramsey, MD. Last updated: April 2016.

Patient J.B. presented the office with chief complaints of coughs and sore throat that lasted about seven days. These symptoms are typically seen in respiratory tract infection or inflammation that is caused by viruses or bacteria. The initial differential diagnoses included Influenza, cough, common cold, community-acquired pneumonia, acute bronchitis, acute pharyngitis, and postnasal drip syndrome based on the chief complaints. The reason that why these differential diagnoses were considered is because they all have coughs as the symptom. Some of these differential diagnoses have both coughs and sore throat. JD, et al. (2017) states that Influenza A or B viruses can cause a dry cough and sore throat. Troullos,

Anne Worrall-Davies* Leeds Institute of Health Sciences, School Of Medicine, University of Leeds, Leeds, UK David Cottrell School of Medicine, University of Leeds, Leeds, UK

Bhatt SP, Nanda S, and Kintzer JS. The Lady Windermere Syndrome: Primary Care Respiratory Journal (2009); 18(4): 334-336. http://doi:10.4104/pcrj.2009.00019

Chronic Obstructive Pulmonary Disease, also known as COPD, is the third leading cause of death in the United States. COPD includes extensive lungs diseases such as emphysema, non-reversible asthma, specific forms of bronchiectasis, and chronic bronchitis. This disease restricts the flow of air in and out of the lungs. Ways in which these limitations may occur include the loss of elasticity in the air sacs and throughout the airways, the destruction of the walls between air sacs, the inflammation or thickening of airway walls, or the overproduction of mucus in airways which can lead to blockage. Throughout this paper I am going to explain the main causes, symptoms, diagnosis, and ways to reduce COPD.