B47-18 Coughing While Driving: How a Motor Vehicle Crash Uncovered Chronic Lung Disease

Introduction Chronic cough is defined as a cough lasting longer than 8 weeks and has a prevalence of approximately 8% in the United States. Common causes include upper airway cough syndrome, asthma, and gastroesophageal reflux disorder. These patients typically have concurrent fatigue, disturbed sleep, urinary incontinence, and other complications related to persistent coughing. Rarely, patients with chronic coughs may experience neuronally mediated syncope, which should prompt evaluation and treatment to reduce the risk of further complications. Case A 56-year-old male with a past medical history of tobacco use disorder, chronic cough, and syncopal episodes presented to establish care with a new primary care provider. The patient was recently admitted following a motor vehicle crash secondary to syncope after a large bout of coughing. The hospitalization evaluation consisted of an echocardiogram to ensure no cardiac etiology of the syncope which was unrevealing. Further history obtained by the primary care provider revealed similar syncopal episodes that started 5 years prior to presentation with no formal diagnosis made. Pulmonary function testing was ordered and the patient was noted to have very severe obstruction with reduced diffusing capacity, consistent with emphysema. Partial reversibility was noted post-bronchodilator treatment with improvement of forced expiratory volume in 1 second by 9%. Previous complete blood count was notable for peripheral eosinophilia. Additional workup was also significant for severe obstructive sleep apnea. The patient was subsequently initiated on triple inhaler therapy with tiotropium-budesonide-formoterol as well as nighttime positive pressure therapy, and on reevaluation reported improvement in chronic cough. Since initiation of treatment for the bronchoconstriction and sleep apnea, patient denied any recurrence of syncopal episodes. Discussion This case highlights syncope as a rare, but previously documented complication of chronic cough. While chronic cough may be initially dismissed, it warrants further workup and management of the underlying condition. Often times, underlying causes of chronic cough can be treated, and allow patients to find relief of their symptoms and complications. In this case, workup was initiated early given the patient’s high risk of serious harm in the setting of syncope while operating a vehicle. As such, the patient saw no more episodes requiring medical care evaluation or hospitalization. In addition to improvement in the patient’s symptoms and quality of life, prompt evaluation and treatment of chronic cough may be associated with significant cost-savings for these patients given their high healthcare utilization rates.