Thank you for referring Cinzia Canturi, a 40-year-old lady who is currently not working, but previously was working in an office and a clothing warehouse. Cinzia is a non-smoker and keeps no pets. She does not take any regular medications but will use Advil, Voltaren and paracetamol on a prn basis for migraines.
Around a month ago, Cinzia developed a dry cough with a tickle in the throat. A couple of days later, she started to notice a choking and the sensation of her throat closing over. She presented to Rosebud hospital and was given a diagnosis of viral upper respiratory tract infection and commenced on Ventolin with a spacer with slight improvement. Thereafter, she started to expectorate thick green phlegm and became aware of a rattly sensation in the chest. Cinzia also noted occasional wheeze and what she describes as a pinching sensation in the chest. She was also aware of some dyspnoea, particularly with vigorous coughing. The cough was initially quite prominent when adopting a supine position or changing position in bed. It is also trigged by …show more content…
I suspect she has had an initial infection such as bronchitis and vigorous coughing has led to laryngeal sensitisation and precipitated spasming of her vocal cords. There may be concurrent reflux and post-nasal drip that are further irritating her larynx. Given that there remains some green discolouration to the phlegm, I have given her a script for roxithromycin. Otherwise the main focus of treatment has to be around reducing any irritants to the larynx. I have suggested she commence Nexium 20mg daily, Nasonex and Fess nasal sprays and I have asked her to cease Seretide and instead use Alvesco and Tilade, both of which can be helpful in diminishing her cough an laryngeal sensitisation. She has had previous issues with codeine thus I have not prescribed her Codeine Linctus. It is imperative that she keeps herself well hydrated and not overuse her
Around a month ago, Cinzia developed a dry cough with a tickle in the throat. A couple of days later, she started to notice a choking and the sensation of her throat closing over. She presented to Rosebud hospital and was given a diagnosis of viral upper respiratory tract infection and commenced on Ventolin with a spacer with slight improvement. Thereafter, she started to expectorate thick green phlegm and became aware of a rattly sensation in the chest. Cinzia also noted occasional wheeze and what she describes as a pinching sensation in the chest. She was also aware of some dyspnoea, particularly with vigorous coughing. The cough was initially quite prominent when adopting a supine position or changing position in bed. It is also trigged by …show more content…
I suspect she has had an initial infection such as bronchitis and vigorous coughing has led to laryngeal sensitisation and precipitated spasming of her vocal cords. There may be concurrent reflux and post-nasal drip that are further irritating her larynx. Given that there remains some green discolouration to the phlegm, I have given her a script for roxithromycin. Otherwise the main focus of treatment has to be around reducing any irritants to the larynx. I have suggested she commence Nexium 20mg daily, Nasonex and Fess nasal sprays and I have asked her to cease Seretide and instead use Alvesco and Tilade, both of which can be helpful in diminishing her cough an laryngeal sensitisation. She has had previous issues with codeine thus I have not prescribed her Codeine Linctus. It is imperative that she keeps herself well hydrated and not overuse her