A case of cough


Your next patient is a florid, plump, forthright woman of 52 years, who is complaining of an irritating cough for the last week or two. She works as a waitress or bartender, and is married with three children. The cough is non-productive and is disturbing her sleep. She admits to getting breathless on climbing stairs, but she is familiar with the symptom and is merely asking for a repeat prescription of her regular cough medicine. The computer records only date back 6 years, so you ask the receptionist to find her old Lloyd George paper records, and in the meantime examine her.


You note her being overweight, almost obese: she weighs 14 stone (90 kg) and is 5 feet 8 inches tall (175 cm), giving her a body mass index of almost 30. You also note her nicotine-stained fingers: she smokes about 20 cigarettes a day, less now, since the ban on smoking at work. Her throat is slightly inflamed. She has a scattering of coarse rhonchi, but no rales. You guess that she may have a mild exacerbation of chronic obstructive airways disease. Her peak flow rate is certainly reduced (300 L/minute).
The records now reveal that she has been prescribed variously simple linctus, ipecacuanha with morphine linctus and pholcodine linctus by one of your predecessors in the practice. 

• What treatment might you rationally advise?
• What other advice might you offer her?
• What further investigation is appropriate?