Approach to a cough (subacute and chronic) Quiz: Ace Your Exams

A 66-year-old man presents to clinic for evaluation of a persistent cough over the past five months. The cough is intermittent and usually dry, but sometimes productive of a small amount of yellow sputum. He has tried nasal saline rinses, oral famotidine, and oral prednisone without relief. The patient quit smoking three months ago, after smoking one pack per day for 40 years, but the cough remains unchanged. He could previously walk up a flight of stairs without stopping but now must stop halfway up to catch his breath. A recent transthoracic echocardiogram was normal. Temperature is 37.4 ºC (99.3 ºF), pulse is 84/min, respiratory rate is 18/min, blood pressure is 133/82 mmHg, and oxygen saturation is 95% on room air. On physical examination, he is well-appearing, and the posterior oropharynx is unremarkable. lungs are clear to auscultation bilaterally, but expiration is much longer than inspiration. An in-office chest radiograph is unremarkable. Which of the following treatments would be most appropriate now?