Peer Responses:

• Length: A minimum of 180 words per post, not including references
• Citations: At least two high-level scholarly reference in APA per post from within the last 5 years
• Relate to another journal reading

Based on the patient’s complaint of a chronic dry cough that lasted for 2 months, the following diagnosis may be considered:

• C34: Malignant neoplasm of bronchia and lung. Based on the patient current medical history of smoking ½ pack of cigarettes for the last 40 years and a new dry cough for 2 months, this issue may be concerned (Harle, et al., 2020). The clinician needs to rule out this condition by ordering a chest X-ray (Harle, et al., 2020). In addition, the clinician needs to complete a thorough physical examination to identify the cough characteristics such as nasal congestion, associated pain, nasal mucosa color and patency, and post-nasal drip existence (Dąbrowska, et al., 2020).
  • Diagnostic test:
    • Chest X-ray to clarify the lung’s structure and abnormality (Harle, et al., 2020).
  • Treatment:
    • Varenicline starts one week before the target quit day (Harris, 2023).
      • Dosage: 0.5 mg orally once daily on days 1 to 3 and is increased to 0.5 mg twice daily on days 4 through 7.
      • Continuing Weeks: 1 mg twice daily after day 8 for 11 weeks
    • If lung cancer is confirmed, the patient needs to be referred to the oncology department for follow-up and treatment options such as radiology or chemotherapy (Harle, et al., 2020)
    • The patient is strongly advised to join a smoking cessation program. And available smoking cessation programs in Massachusetts including (Commonwealth of Massachusetts, 2024):
      • 1-800-QUIT-NOW – offering one-on-one coaching to help you quit tobacco
      • Massachusetts Tobacco Cessation and Prevention Program (MTCP) – helping current tobacco and nicotine users to quit with a behavioral program.
  • Follow-up:
    • The patient should be checked in 4 weeks for a new medication evaluation.
• N32.8 Overactive bladder is a common consequence of long-term smoking population (Scarneciu, et al., 2021). The clinician should perform a physical examination including how often the patient urinates, pain associated with urination, color, smell of the urine, etc. (Scarneciu, et al., 2021)
  • Diagnostic test:
    • A residual postvoid via ultrasound sound be performed to evaluate bladder muscle functions on empty urine (Scarneciu, et al., 2021)
    • Urinalysis and urine culture is checked to rule out infectious sources (Scarneciu, et al., 2021).
  • Treatment:
    • Non-pharmacological intervention:
      • Behavioral therapy focuses on smoking cessation, restrict stimulant drinks such as alcohol, caffeine (Scarneciu, et al., 2021).
      • Bladder training and pelvic floor muscle training (Scarneciu, et al., 2021)
    • Pharmacological treatment
      • Oxybutynin 5 mg PO once daily (Scarneciu, et al., 2021)
  • Referral: the patient does not need a urologist referral at this moment. If his condition is controlled with lifestyle modifications and medication, a urologist referral will be considered.
  • Follow-up:
    • The patient should be checked in 4 weeks for a new medication evaluation

References

Commonwealth of Massachusetts. (2024). Massachusetts Tobacco Cessation and Prevention Program (MTCP). Retrieved from https://www.mass.gov: https://mass.gov/info-details/about-the-massachuse…

Dąbrowska, M., Arcimowicz, M., Grabczak, E. M., Truba, O., Rybka, A., Białek-Gosk, K., . . . Krenke, R. (2020). Chronic cough related to the upper airway cough syndrome: one entity but not always the same. Eur Arch Otorhinolaryngol.

Harle, A., Molassiotis, A., Buffin, O., Burnham, J., Smith, J., Yorke, J., & Blackhall, F. H. (2020). A cross sectional study to determine the prevalence of cough and its impact in patients with lung cancer: a patient unmet need. BMC Cancer.

Harris, E. (2023). Systematic Review Finds the Most Effective Smoking Cessation Aids. JAMA.

Scarneciu, I., Lupu, S., Bratu, O. G., Teodorescu, A., Maxim, L. S., Brinza, A., . . . Scarneciu, C. C. (2021). Overactive bladder: A review and update. Experimental and Therapeutic Medicine.