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also experience coughing up blood
(rust-coloured sputum), chest pain,
hoarseness, weight loss, loss of appetite,
shortness of breath, weakness, and
new-onset wheezing.8 Unfortunately,
most symptoms of lung cancer are likely
to occur once the disease has spread
throughout the body.
Eliza informs you that she has not
been experiencing any of the other
symptoms associated with lung cancer,
such as coughing up blood, chest pain,
wheezing, shortness of breath or weight
loss. It therefore appears that lung cancer
is an unlikely cause of her current symptoms.
Asthma is a chronic disease of the
lungs, which can cause mild to severe
Common symptoms of
asthma include wheezing, shortness of
breath, chest tightness and coughing.
Symptoms are usually worse in the early
morning, and at night time, or when
triggered by exercise or exposure to an
Asthma is more common in
patients who have a history of allergies.
You speak with Eliza and discover
that she does not have diagnosed
asthma. She is not experiencing any issues
with breathing, shortness of breath or
chest tightness. Eliza also informs you that
she has been tested for asthma in the past
(due to some issues with breathing when
at the gym), but her doctor advised her
that she was not suffering from the
condition. As a result, it seems that asthma
is not the cause of her current cough.
Gastro-oesophageal reflux disease
(GORD) is a common condition which
causes symptoms such as heartburn
and acid regurgitation.
In some cases
of GORD, patients may experience a
However, it is difficult
to determine if the chronic cough is
always related to GORD itself, or if it is
caused by another pathology.
also been suggested that in cases of
chronic cough related to GORD, patients
may not actually experience reflux
symptoms, making the overall diagnosis
of GORD difficult.
Eliza to wake up). She indicates that there
is rarely any sputum produced, and she is
not experiencing any associated shortness
of breath, chest tightness or wheeze.
Apart from the cough, Eliza has been
feeling generally ‘run down’ as she has had
a hard few months at work, with lots of
travel. That is why she started taking some
natural remedies to help her immune system.
Do you have any medical conditions?
Are you taking any medicines at the
moment (including over-the-counter
(OTC) and herbal medicines)?
Eliza has chronic migraines for which
she takes sumatriptan 50 mg as
needed. She also takes the occasional
paracetamol for minor headaches
or other mild pain. Six months ago,
Eliza was diagnosed with hypertension,
for which she was prescribed perindopril
arginine 2.5 mg once daily. For the last
3 weeks Eliza has been taking olive leaf
extract (1 capsule per day) and vitamin C
(500 mg chewable tablets per day) to try
to boost her immune system. She also
takes feverfew tablets (340 mg daily),
as she believes this has reduced the
frequency of her migraines.
Eliza has a persistent dry cough.
There are several potential causes of her
Viral or bacterial respiratory tract
infections (such as influenza, bronchitis,
pneumonia or pertussis) can be
associated with a cough. In some cases,
a cough associated with infection can
be caused by post-nasal drip, where
secretions irritate the throat, and hence
require regular clearing.
caused by post-nasal drip is also called
upper airway cough syndrome.
often most common in the morning, as
secretions can gather overnight.
Pertussis (whooping cough) is an
extremely contagious bacterial
respiratory tract infection which typically
commences as a cold (i.e. runny nose,
low grade fever, mild and occasional
During the later stage of the
illness (after 1–2 weeks) the patient
usually experiences paroxysms (fits) of
coughs, which are followed by a high
pitch ‘whoop’ sound. These coughing fits
can continue for 10 weeks or more.3
In some cases of viral infections, patients
can experience a dry post-infective
cough (also called a post-viral cough)
which persists for up to 8 weeks.
Eliza does not indicate that her
cough is worse in the mornings.
She confirms that her cough is consistent
throughout the day, and some nights.
Eliza also informs you that she does not
have coughing fits (she usually coughs
three or four times, and then it subsides),
and there is no ‘whoop’ sound after she
coughs. In addition, Eliza has been
coughing for 3 months, which is longer
than expected for a post-viral cough.
As Eliza is not experiencing any other
symptoms of a viral or bacterial infection,
and her cough has extended over
3 months, it does not appear that an
infection is the cause.
Patients with allergic rhinitis (or hay
fever) can experience a regular cough,
which may occur soon after lying down
Allergic rhinitis is caused by
allergy to a variety of items, such as dust
mites, animals, pollens or moulds.
The most common symptoms of this
condition are a runny or blocked,
itchy nose, sneezing, red and watery,
itchy eyes, and an itchy throat.
complicated cases of allergic rhinitis,
patients may also experience sleep
disturbance, daytime fatigue, headaches
and poor concentration.
Upon further questioning, you
discover that Eliza does not suffer
from hay fever. She has not been
experiencing a runny, blocked or itchy
nose, sneezing, red, watery or itchy eyes,
or an itchy throat. It does not appear that
allergic rhinitis is the cause of her cough.
Lung cancer is one of the 10 most
common cancers in Australia.
A persistent and/or worsening cough
is a common symptom of lung
In addition, patients may
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