Presenting Complaints

• 37-year-old male presenting with a chronic, persistent cough for the past 6 months.

History of Presenting Complaint

• The cough started gradually about 6 months ago and has been present daily since then.
• The cough is usually dry and nonproductive, but occasionally he brings up small amounts of clear phlegm.
• The cough is worse in the mornings and when he is exposed to cold air or dust.
• He denies any associated chest pain, shortness of breath, wheezing, or fever.
• He reports that the cough interferes with his sleep and causes him to feel fatigued during the day.
• He has tried over-the-counter cough suppressants, but they provide only temporary relief.

Significant Positives & Negatives For Differentials

Chronic Bronchitis

Positives:

• Chronic, persistent cough for 6 months
• Dry, nonproductive cough with occasional clear phlegm
• Cough worse in the mornings and with exposure to cold air or dust
• History of childhood asthma, well-controlled with occasional use of albuterol inhaler

Negatives:

• No history of smoking or significant exposure to air pollutants
• No evidence of airflow obstruction or hyperinflation on physical exam

Asthma-related Cough

Positives:

• History of childhood asthma, well-controlled with occasional use of albuterol inhaler
• Cough worse with exposure to cold air or dust, suggesting airway hyperresponsiveness

Negatives:

• Cough is chronic and persistent, rather than episodic
• No clear triggers for asthma exacerbations (e.g., viral infections, exercise)

Interstitial Lung Disease

Positives:

• Chronic, persistent cough

Negatives:

• No history of exposure to known causes of interstitial lung disease (e.g., occupational exposures, connective tissue disorders)
• No evidence of restrictive lung disease on physical exam or imaging

COPD

Positives:

• History of childhood asthma, which can be a risk factor for COPD
• Chronic, persistent cough

Negatives:

• No history of smoking or significant exposure to air pollutants
• No evidence of airflow obstruction or hyperinflation on physical exam

Postnasal Drip

Positives:

• Chronic, persistent cough
• Cough worse in the mornings, suggesting postnasal drip

Negatives:

• No associated symptoms of nasal congestion, rhinorrhea, or sinus pressure

GERD

Positives:

• Chronic, persistent cough

Negatives:

• No symptoms of heartburn, regurgitation, or dysphagia

Past Medical History

• Childhood asthma, well-controlled with occasional use of an albuterol inhaler
• No history of other chronic respiratory conditions

Drug/Medication History

• Albuterol inhaler as needed for asthma symptoms

Social History

• Works as an office manager, spends most of the day sitting at a desk
• Non-smoker, occasional social drinker
• No history of recent travel or sick contacts

Family History

• Father has COPD, mother has asthma

Systems Review

• Positive for chronic cough, otherwise negative for fever, chills, night sweats, unintentional weight loss, chest pain, shortness of breath, wheezing, or hemoptysis.

Ideas, Concerns & Expectations

• The patient is concerned that the cough may be a sign of a more serious underlying condition and would like to determine the cause in order to find an effective treatment.

Case Presentation

Based on the patient's presentation and the significant positives and negatives for the differential diagnoses, the most likely diagnosis is chronic bronchitis or asthma-related cough. The patient's history of childhood asthma, chronic cough without other respiratory symptoms, and lack of risk factors for other conditions like COPD or interstitial lung disease, suggest that chronic bronchitis or asthma-related cough are the most likely explanations for the patient's persistent cough.