35,F,c/o refractory dry cough since a month more in the evening hrs.not asso with fever,wt loss etc. bronchodilators,antibiotics, antihistaminics, Rx for GERD,given.routine lab,IGE,ESR,Ab E counts normal.PFT,ECHO normal.not on any chronic medications. RS clear, CT thorax and cxray displayed. plz sugg further management.

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Grossly normal Xray CT thorax also normal Somatic cough syndrome has to be ruled out...some facts about it from literature The ACCP guidelines recommended that the diagnosis of somatic cough syndrome (psychogenic cough) can only be made after extensive evaluation has been performed, uncommon causes of cough are excluded, and the patient meets the DSM-5 criteria for a somatic symptom disorder. These DSM-5 criteria include one or more somatic symptoms that are distressing or result in significant disruption to daily life. There may be disproportionate and persistent thoughts about the seriousness of the symptoms, high levels of anxiety about symptoms or excessive time and energy devoted to the symptoms. In patients diagnosed with somatic cough syndrome, non-pharmacologic trials of hypnosis, suggestion therapy, reassurance, counselling or a referral to a psychologist or a psychiatrist are recommended

Sir xray in normal , CT is also normal and as you mentioned all other possible investigation which can be done are also normal and not relieved by any medication , sir you can try for evaluating the patient for ? psychogenic cough .

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Hrct is normal xray chest hyperventilated otherwise normal dear dr Sandeep going by history it is not a infective cough and she is not responding to bronchodilators i feel lungs are hyper ventilated better to keep on nebulisation or rotahalers she is dysponeic since rest investigations are normal simple cough sedatives should help.

Thanks sir,she is on DPI ,she has evening time cough last for 2 to 3 hrs.chest examination is clear.
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Rule out history of cold recent few weeks back (virus can persist in the airway leading to irritation) , 2>> osa .. can also present with cough... with h/o insomnia n sleepless nghts., 3>>gerd r/o by endoscopy.. ..

Thanks sir!I have given her antivirals also.treated for GERD as well. Not seen in view of OSA.
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Diffusely scattered centrilobular nodules in both lung with ground glass haziness suggest acute interstitial pneumonia Ddx Tubercular NSIP / acute HP

Pt is taking any medicines like betablocker or ibuprofen ,antihypertensive like AC inhibiter containg drugs or not ?

Pt is Not on any medications sir!
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Antitussive,may be tried,tab.Alprazolam 0.25mghs.may be given .quite rest can be helpful for recovery.

Thanks sir!
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Chronic refractory unprodutive cough is occasionally seen in practice.It is very difficult to trace the origin of this type of cough.this may be due to irritation of the diaphrgm or phrenic nerve or its neucleus. further Psychogenic origin (to attract sympathy or attention) must be ruled out.Irrational use of Beta blockers or a select group of antihypertensives can also cause hiccough as I have observed in my practice.

Chest scan NAD.

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