You are introduced to TW, a famous 82-year-old golfer at a Tucson AZ golf function. He has been visiting here for the last 3 months overseeing the construction of a golf course he designed. When he finds out you are a pharmacist, he asks if there is anything stronger than promethazine with codeine for coughing spells that have been bothering him for the last 4 weeks. It seems to be worse at night. He finished a 10-day course of amoxicillin 2 weeks ago for a cough “that went to his chest.” He also complains about his recent 10-lb weight gain and the shot of him on TV last night made him look “fat as a hog.” “Even my feet are getting fat! Why even my favorite slippers are getting tight.” An excellent historian, TW tells you about his long-standing hypertension, which is treated with carvedilol and doxazosin (also for his prostate), and coronary artery disease that resulted in a tiny heart attack that led to a four-vessel CABG 15 years ago. He also takes aspirin, tiotropium inhaler for his smokinginduced COPD, and atorvastatin. You notice that his breathing appears to somewhat rapid.
Given TW’s history and his current complaints, list three possible causes for his coughing attacks. Explain your rationale.
List six questions, examinations, or tests you would ask/order/perform to help clarify his diagnosis. Explain your rationale.
