IN-CLASS/ONLINE CASE STUDY
Chronic Cough Evaluation
Patient Profile
C.G. is a 38-year-old male who comes to the health care provider with complaints of a “cough that won’t
go away.”
Subjective Data
 Has had a dry, hacking cough intermittently for the last 2-3 months
 Not taking any medications
Objective Data
Physical Examination
 Blood pressure 134/76, pulse 88, temperature 98.4° F, respirations 24
 Oxygen saturation 97% on room air
 Height 5'11", weight 190 lbs
Discussion Questions
1. Describe the questions you would ask C.G. to specifically evaluate his cough.
Answer: To assess a cough, first, evaluate the quality of the cough. Is it loose-sounding, dryhacking or harsh-barky? Assess whether the cough is strong enough to clear secretions and note
if it is productive or nonproductive of secretions. Determine if a cough is acute or chronic, or if it
first began with an upper respiratory infection. What has been the pattern of coughing? Has it
been regular or paroxysmal? Is it related to a time of day, weather, or certain activities, such as
talking or taking deep breaths? Has it changed over time? Does he clear the throat a lot? What
has he done to try to alleviate the cough? Did he try any prescription or over-the-counter drugs?
Does he have any pain when coughing?
2. What information should you obtain as part of a smoking history?
Answer: As part of a smoking history, ask C.G. if he has ever smoked and if he currently smokes.
If he responds affirmatively, then ask how many years he smoked and how many packs he
smoked per day. Calculate the pack-year history. In addition to asking about cigarette use, find
out about the use of any tobacco products, including cigars, pipes, chewing tobacco, and
smokeless tobacco products. Inquire about exposure to secondhand smoke. If he does smoke,
assess if he has made any effort to quit.
3. What additional health history information would you obtain from C.G.?
Answer: Assess C.G. for the presence of any accompanying symptoms, including chest pain,
orthopnea, dyspnea, and exercise intolerance. Inquire about his ability to participate in his usual
activities and the relationship between his symptoms and activity. Inquire about his work and
any exposure to any fumes or toxins. Ask his about any changes in weight, nutritional intake,
vaccination status, exercise routine, recent travel, tobacco and alcohol use, and medication use.
Review his past medical history, inquiring about any allergies, asthma, pneumonia, respiratory
infections, and COPD.
4. What are common causes of a chronic cough? What are three specific questions regarding each
cause you could ask C.G.?
Answer:
Asthma
• Do you have a history of any allergies?
• Do you ever experience wheezing?
• Do you experience chest tightness or SOB?
• Does the cough start with exercising, high pollen counts, being around animals, cold air, or
illness?
Sinus disorder
• Do you have a history of any allergies or sinus problems?
• Do you feel any drainage or a tickle in the back of your throat?
• Do you clear your throat a lot?
 Do you feel like you have had bad breath or a foul taste in your mouth?
Gastroesophageal Reflux Disease
• Do you experience acid reflux (does stomach acid come up into your throat)?
• Do you have heartburn after you eat certain foods or beverages, go to bed within 4 hours of
eating a meal, exercise too soon after eating, or overeat?
• Do you take antacids or some type of stomach medication? If so, how often?
• Has an antacid helped your cough?
COPD
 Do you feel there has been any change in your overall health?
 Have you had any sputum produced with your cough? If so, what is it like?
 Have you had any decrease in appetite or lost any weight?
5. Describe what C.G.’s physical assessment would include.
Answer: Observe his overall appearance and note his respiratory effort. Moving from head to
toe, inspect the nose for patency, inflammation, deformities, symmetry, and discharge. Inspect
the interior of the mouth for color, lesions, masses, gum retraction, bleeding, and poor
dentition. Inspect the tongue for symmetry and the presence of lesions. Observe the pharynx
and note the color, symmetry, and any enlargement of the tonsils. Inspect the neck for
symmetry and presence of tender or swollen areas; palpate the lymph nodes and tracheal
position. Determine the shape and symmetry of the chest. Observe for abnormalities in the
sternum and for chest excursion. Note an increase, decrease, or absence of fremitus and
percuss the lung fields. Auscultate the lungs. Auscultate heart and lung sounds; palpate the
abdomen. Inspect the skin and nails for color and any lesions. Check for the presence of
clubbing.
6. What noninvasive diagnostic tests may be ordered and what each would contribute?
Answer: Tests that may be ordered for C.G. include:
 Sputum culture – diagnose a bacterial infection
 Chest x-ray – diagnose a structural abnormality in respiratory system
 Pulmonary function tests (PFTs)–detect any alterations in lung volumes and
airflow
 Skin testing– determine if any allergies or tuberculin infection are present
 Hematocrit – an increased hematocrit is found in chronic hypoxemia
 Exercise testing– used to determine exercise capacity