A 60-year-old woman with a history of asthma presents with a chronic cough and increasing shortness of breath over the last six months. She has never smoked and reports no recent respiratory infections. Her asthma medications do not seem to help these symptoms. What could be the potential causes and next steps?
While this woman has a history of asthma, her chronic cough and progressively worsening shortness of breath that is not responsive to her usual asthma medications raise the concern for other diagnoses. Other potential causes could include chronic obstructive pulmonary disease (COPD), despite her lack of smoking history, interstitial lung disease, or even a cardiac cause like heart failure. The next steps would include a detailed physical examination, spirometry with bronchodilator testing, chest imaging (like a chest X-ray or CT scan), and possibly referral to a pulmonologist for further evaluation.