A 65-Year-Old Woman With Intractable Cough

A 65-year-old woman was referred for a second opinion regarding a 7-month history of a persistent, progressive, nonproductive cough. Her cough occurred several times a minute, causing a significant impact on her daily activities. She denied fever, chills, weight loss, chest pain, wheezing, symptoms of gastroesophageal reflux, or postnasal drip. She was a never smoker with no history of asthma, allergies, sinus disease, or dermatitis. She had never taken an angiotensin-converting enzyme inhibitor. Her medical history included rheumatoid arthritis, for which she was treated with methotrexate for 3 years. She denied any occupational or environmental exposures. She was previously treated with a short-acting β-agonist, inhaled corticosteroid/long-acting β-agonist, montelukast, nasal steroids, a proton pump inhibitor, gabapentin, and azithromycin without relief. She also received codeine, which provided mild relief.