61 year?old man presents to OPD with complaints of persistent, non-productive cough for 1 month. He has no other symptom. He is smoking around 20 biddis per day for last 25 years. Physical examination is normal. What is the line of management in such patients?: (A) Reassurance and advise him to quit smoking, (B) Prescribe oral antibiotics for 7 days, (C) Do a chest X ray and refer him to smoking cessation clinic, (D) Go for a CT thorax to visualise pathology
Answer is C. Lung cancer Most common symptom in chronic smokers is persistent cough and chest X Ray is a must for such patients. Smoking cessation can reduce risk of lung cancer. Cessation at or before middle age can reduce the chances of lung cancer by 90% But in this case scenario, patients is elderly and will not have a strong will to achieve the goal of smoking abstinence. Therefore after doing a chest X ray, he must be referred to smoking cessation clinics so that compliance can be monitored and effective counselling can be done .