A 53 Year Old Man with Complains of Night time Cough For 6 Weeks

A 53-year-old male is accompanied by his wife to your office and complains of a cough for 6 weeks. It is worse at night and any time he lies down. He denies sputum production, shortness of breath, chest pain, and wheezing. He takes an antacid once or twice per day to settle his stomach and notes very bad heartburn. He smoked three packs of cigarettes per day until 1 year ago, when he quit “cold turkey.” He takes only hydrochlorothiazide for hypertension and a daily aspirin. He has no cardiac disorders. His wife reports that he snores at night, and she adds, “He’s always hacking and clearing his throat—all night.” The review of systems is negative. In order to sleep better, he has recently started having a shot of whiskey before going to bed.

What is the most likely cause for the cough?
A) Gastroesophageal reflux.
B) Lung cancer.
C) Antihypertensive medication.
D) Alcohol abuse.
E) Congestive heart failure (CHF).

Answer And Discussion

The correct answer is “A.” Gastroesophageal reflux.

This patient appears to have a chronic cough that is most likely due to gastroesophageal reflux disease (GERD). He takes antacids and exhibits throat clearing, which can be a subtle sign and is not typically identified by patients as reflux. Additionally, he drinks alcohol at bedtime, further predisposing to reflux. He has a history of smoking, which does place him at increased risk for
developing a bronchogenic carcinoma, but a lung mass would not be a common cause for cough. Aspirinis associated with bronchospasm in some people, but it would not usually present as cough in a patient with no history of asthma. Hydrochlorothiazide is not known to cause cough (although angiotensin-converting enzyme [ACE] inhibitors are). Also, it is unlikely that symptoms would be isolated to nighttime if his cough was medication related.