The patient presents with a 3-month history of dry and hacking cough. His subjective evaluation will require asking for additional signs that could accompany the cough. These include any history of shortness of breath, chest pain, easy fatiguability, and exercise intolerance. The characteristics of the cough should also be determined, including timing variations, associated sputum production or hemoptysis, and any triggering, aggravating, or relieving factors (Sharma et al., 2023). Additional questions can focus on the patientâ€™s history of smoking, weight changes, fever, occupational conditions, etc. (Sharma et al., 2023)
Cough mainly results following a respiratory problem or cardiovascular issue; hence, these systems form the main areas of concern for a patient with a cough. However, assessing the head, ear, nose, and throat will also be pertinent as these organs are interconnected with the respiratory tract and may trigger a cough. The central nervous system also needs to be evaluated for any lesion that may be causing the cough (Al-Biltagi et al., 2022).
The tests required for the patient include a sputum culture for bacterial and fungal infections. Spirometry will also be necessary to rule out obstructive lung diseases by checking the FV1/FV ratio (Agarwal et al., 2023).
The patient has been using Lisinopril. This angiotensin-converting enzyme inhibitor usually triggers cough as a side effect resulting from the accumulation of substance P and bradykinin in the upper respiratory tract (Pinto et al., 2020). Therefore, the patient is most likely having a drug-induced cough. Differential diagnoses include asthma and chronic obstructive pulmonary disease, with asthma resulting from his environmental allergies.
Treatment will require the patient to stop the use of Lisinopril and prescribe an alternative medication. The patient can be prescribed a beta-adrenergic blocker, a calcium channel blocker, or a diuretic to manage hypertension (Ojha et al., 2021). Educating the patient on the drugsâ€™ side effects and possible lifestyle modification techniques, such as regular exercise and proper diet, can be a part of the non-pharmacological management of his hypertension and diabetes.