Irene Felipe's Blog: Inhale, Exhale

I have an elderly patient who lives near an active volcano. His family moved there a few years ago. Unfortunately, he's allergic to the ash and vog that the volcano regularly spews. He wakes up every day with a runny nose, postnasal drip, and a cough that resolves within an hour. He was given a maintenance anti-histamine by his doctor who told him that his allergy is an unavoidable result of aging, and to just accept it as a part of life. This didn't make sense to me, as other medications can be tried before writing off allergic rhinitis as simply a "fact of life." I've started him on a steroid nasal spray and told him to follow up in 2-4 weeks. Here's to hoping that I can improve his quality of life.
I have another patient who presented with a cough productive of yellowish phlegm for a week. He immediately requested azithromycin, as he said that most of his doctors usually prescribed it whenever he consulted them for a cough. Although I eventually did prescribe an antibiotic (because he's elderly, is asthmatic, and has multiple co-morbidities), I told him that most coughs are actually not bacterial in origin and that he shouldn't ask for or expect an antibiotic each and every time he gets a cough. I also requested a chest X-ray. Fortunately, he was open-minded and agreed.
My husband (an infectious diseases consultant) sometimes jokes that he won't have a job anymore in the near future (because there'll be no antibiotics for him to prescribe owing to horrendous bacterial resistance), but I can tell that he's not really joking.