CASE SCENARIO:

A 2-year old child presents to the clinic with a cough that started 5 weeks ago when he caught a bad
cold from his 5-year old brother.  The cough is present all the time and sometimes if so bad that it
makes him throw up.  He has had 2 other similar coughing episodes with colds that cleared up
slowly each time. There is no fever. His weight is following the curve at the 10 th percentile.
Otherwise, he has been healthy and has no complaints. On PE, the lungs are clear.

STUDY GUIDE QUESTIONS:

1.       What additional information from the history will assist you to narrow the differential
diagnosis for this patient?

2.       What is the most likely diagnosis for this patient?

3.       What laboratory work up will help in the diagnosis of this patient?

4.       How would you manage this patient?

Answers:
1. Immunization status specially pertussis vaccine and family history of asthma or atopic
disorders. Exposure history such as siblings, other family members and day care. Ask also
about the child’s physical activity that is limited by cough. Also, if there are any medications
that have been tried for the cough. Also note for the child’s response.
2. It is likely a virally triggered asthma. In such cases, wheezing is not always present.
Recurrent cough with upper respiratory infections is suspicions as diagnosis.
3. Since the child is too young for a pulmonary function test, and a chest radiograph will not
likely provide any useful information, a therapeutic trial of inhaled bronchodilator such as
albuterol may result in reduction in cough or occasionally will prompt the appearance of
wheezing.
4.  Pharmacological interventions shown to be relatively successful at preventing asthma
exacerbations include inhaled corticosteroids and their combination with long lasting β 2-
agonists, leukotriene modifiers and anti-immunoglobulin E therapy. Corticosteroids
suppress eosinophilic inflammation through various pathways

Carlos D. Achondo Jr. 3MD