Cough in a 54-yr-old Man

Past Medical History

  • Medical history: Hypertension since age 42, well-controlled with medications. Hypercholesterolemia since age 50, poorly controlled with diet. No history of chronic obstructive pulmonary disease (COPD), asthma or other lung disease, coronary artery disease, renal disease, cancer, diabetes, or immunosuppressive disorders.

  • Surgical history: Tonsillectomy at age 10 yr; ligament repair of the right knee at age 26.

  • Medications:Chlorthalidone 25 mg once/day and enalapril 40 mg once/day for the past 6 yr.

  • Allergies: No known drug allergies. No seasonal allergies.

  • Family history: Mother is age 80 and has hypertension, type 2 diabetes, and high cholesterol. Father died at age 64 of coronary artery disease (CAD).

  • Social history: Patient is employed as a lawyer. He plays squash vigorously twice a week, is poorly compliant with a low-fat diet, and consumes about 6 to 8 alcoholic drinks/wk. He smoked 1 pack of cigarettes/day for 20 yr but quit smoking at age 44; he denies other drug use. His most recent travel was a Mediterranean cruise 8 mo ago; it included land excursions to Turkey, Greece, and Italy. No other recent travel. He has not had any history of recent immobilization. He has no known exposure to anyone with tuberculosis (TB) or other respiratory illness. He has not had unprotected sex with anyone other than his spouse for the past 3 yr. He has had annual flu vaccinations for the past 4 yr.