What is the diagnosis for a 68-year-old female presenting with a worsening dry cough, shortness of breath, and fatigue, taking Mucinex (Guaifenesin) with no relief, and experiencing headache, nasal congestion, and rhinorrhea, with a history of chronic nasal congestion due to seasonal allergies, and radiographic findings of perihilar thickening with opacities?

From the Guidelines

This patient has acute bronchitis, likely viral in origin, and should be treated with a combination approach to manage symptoms and prevent complications, as most cases resolve within 2-3 weeks without antibiotics 1. The patient's symptoms, including a dry cough for 6-7 days, shortness of breath, fatigue, headache, nasal congestion, and recent wheezing, along with the chest X-ray showing perihilar thickening with opacities, support this diagnosis.

• Continue the Mucinex (guaifenesin) 600mg every 12 hours to help thin secretions.
• Add an albuterol inhaler, 2 puffs every 4-6 hours as needed for wheezing and shortness of breath.
• For symptom relief, take acetaminophen 500mg every 6 hours as needed for headache and discomfort, not exceeding 3000mg daily.
• Increase fluid intake to at least 8-10 glasses of water daily to help thin secretions.
• Rest is essential for recovery.
• Use a humidifier at night to ease breathing and coughing. Given her age and the presence of wheezing, monitoring her respiratory status is crucial to prevent progression to pneumonia, and she should follow up with her primary care provider in 7-10 days if symptoms persist or worsen 1. It's also important to note that the patient's chronic nasal congestion due to seasonal allergies may be contributing to her symptoms, and treatment of her allergies may help alleviate her cough, as rhinosinusitis is commonly associated with chronic cough 1. However, the recent study from 2021 suggests that chest CT may not be necessary in the initial evaluation of patients with chronic cough, and its use should be reserved for patients with abnormal chest radiographs or those with clinical suspicion of underlying disease 1.

From the Research

Patient Presentation

• The patient is a 68-year-old female presenting with worsening cough, shortness of breath, and fatigue over 6 to 7 days.
• She reports a dry cough and is taking Mucinex with no relief.
• Associated symptoms include headache, nasal congestion/rhinorrhea, and chronic nasal congestion due to seasonal allergies.
• The patient denies any history of COPD or asthma.
• Recent symptoms include rattling in her chest with wheezing, and X-ray results show perihilar thickening with opacities.
• The patient was discharged with instructions for bronchitis.

Relevant Studies

• A study from 1998 2 compared the efficacy of a 5-day and a 3-day course of azithromycin for the treatment of atypical pneumonia, finding that azithromycin is equally effective in adult patients if given for 3 or 5 days at the same total dose.
• A 2020 study 3 explored the effectiveness and safety of oral corticosteroids in the treatment of early-stage SARS-Cov-2 pneumonia in patients who do not meet hospital admission criteria, with azithromycin as part of the treatment regimen.
• A 2018 case series 4 reported positive responses to treatment with pirfenidone, azithromycin, and prednisolone in patients with post-H1N1 ARDS pulmonary fibrosis.
• A 2011 randomized trial 5 found that azithromycin decreased the frequency of exacerbations in patients with COPD who had an increased risk of exacerbations.
• A 2022 analysis 6 from the BAT randomized controlled trial found that long-term azithromycin improved radiological features in patients with bronchiectasis, particularly consolidation and parenchymal changes.