Nothing to Cough At

A CLINICAL PROBLEM-SOLVING article by Paul Cornia from Veterans Affairs Puget Sound Health Care System in Seattle, Washington.
A 73-year-old man presented to the emergency department with a 4-day history of nonproductive cough that worsened at night. He did not have fever, nasal congestion, sore throat, hemoptysis, chest pain, or dyspnea.
The patient had a history of coronary-artery disease, hypertension, and possible aortic stenosis. He reported that none of his medications had been started recently. His vital sign was normal. A chest radiograph was normal.
The emergency department physician thought the patient's cough was probably related to the use of lisinopril and advised that the drug be replaced with an angiotensin-receptor blocker.
One week later, the patient returned to the clinic and reported that, despite the change in medication, the cough had worsened. It was present throughout the day but remained particularly bothersome at night and disrupted sleep.
Cough is one of the most common symptoms for which patients see their primary care physicians. The differential diagnosis for cough is broad and encompasses disorders that range from those that are relatively benign to those that are potentially life-threatening. The duration of cough at the time of presentation is a useful first step toward narrowing the differential diagnosis.
This case describes an important, but often overlooked, cause of cough.

coughは厄介だ。その名のジャーナルがあることからも察することができる。臨床的においてのみならず、語学的な意味においても、また厄介だ。

• [ɔ́ː] bought, brought, thought, fought, sought, nought, daughter, naughty...
• [óu] though, although, dough（３語）
• [uː] through（１語）
• [áu] bough, drought, plough（３語）
• [ou/ə] thórough, bórough（２語）
• [ʌ́f] enough, rough, tough（３語）
• [ɔ́(ː)f] cough, trough（２語）
• [ʌp] hiccough（１語）