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Case Study: Assessing Chronic Cough – Are Medications Helping?

I’m thinking out loud here on this medication list, so feel free comment below, if there is something that stands out to you or questions you’d like to know!  We are all in this together 🙂

A 99 year old female is on the following medications:

  • Lasix 40 mg daily
  • Flonase 1 spray each nostril daily
  • Albuterol nebs as needed
  • Mucinex 600 mg twice daily
  • Prilosec20 mg daily
  • Zantac 150 mg at bedtime
  • Remeron 15 mg at bedtime
  • Calcium and VitaminD 600/400
  • Femara 2.5 mg daily
  • Cough Drops with Menthol as needed

Past medical history includes CHF, Rhinitis, Chronic cough, Gerd, Depression, Dementia, osteopenia, and Breast Cancer

Current labs reveal

  • Hemoglobin = 9.4
  • Creatinine = 0.71
  • Potassium = 3.6

My first thoughts on this scenario would be to look the symptoms of chronic cough, rhinitis, and GERD.  I’ve seen numerous scenarios of patients with chronic cough being put on several different medications to help treat the cough and then those medications never being reassessed for efficacy.  With this patient being 99 years old, comfort will most likely be a high priority.

This patient also has a significantly low hemoglobin, so assessing GI status would be important to do.  If there was concern of GI bleeding or something like this, we would be a lot less likely to try to reduce the Zantac and Prilosec.  Many times patients of this age (likely me included if I’d be lucky enough to make it to that age) will not want new problems worked up.  This may very well be the case with the anemia.  Remember that lab trends are critically important.  Symptoms are also very important when it comes to deciding how to manage anemia.  Maybe this patient has chronically had a lower hemoglobin and is asymptomatic at this level.  These are just a few things to consider. Further investigation into B12, Folate, Iron could also be of value.

Assessment of the rhinitis symptoms and length of Mucinex and Flonase use associated with the timing of those symptoms would be important factors to consider.  Along with that it would be prudent to check out the albuterol use.  When assessing chronic cough, remember that it can be an atypical sign of GERD and that could be part of the reason why the H2 blocker and PPI are being used or why this patient was initially put on them.

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Written By Eric Christianson

August 16, 2015

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