case

Six-year-old Ms. Patel Sunita came to the clinic with persistent cough symptoms that had persisted for eight weeks. There is no exposure to secondhand smoking at home.

Cough for eight weeks

History of allergic rhinitis

Recently move to area three months ago

No fever, wheezing, or shortness of breath

There are no smokers in the house, have one dog, carpets in the bedrooms.

Mild end-expiratory wheezing

Chronic nasal congestion

It is often worse at night, exposure to cold air makes it worse

PMH of eczema

Cough is occasionally triggered by laughing or crying.

Denies stomachaches. No vomiting or diarrhea

Normal vital signs

Exercises

Family history of mother and cousins have asthma

No sinus tenderness when the frontal sinuses are palpated. No facial tenderness.

Transverse nasal crease. Turbinates are somewhat pale and edematous. Clear nasal secretions.

More nasal congestion since moving

Sunita, a 6-year-old girl with eczema and persistent nasal congestion, appears with a chronic cough for 8 weeks that is frequently worse at night, after exercising, and when exposed to cold air. She doesn't have a fever, shortness of breath, or history of wheezing, but she does have an asthmatic family. Patel has never taken medication, and he has no allergies to any foods or substances. The home has one dog, carpets in the bedrooms, and other amenities. At home, she is not exposed to secondhand smoke.

Moderate persistent asthma

Cough for two months, associated with wheezing at night

Lungs: No evidence of retractions or a hyperinflated thorax. No changes to percussion or E-to-A changes. Normal I:E ratio. End-expiratory wheezing. No use of accessory muscles.

No fever, wheezing, or shortness of breath

Nose: Transverse nasal crease. 

Turbinates. Somewhat pale and edematous. Clear nasal secretions. No sinus tenderness when the frontal sinuses are palpated. No facial tenderness.

It is often worse at night, exposure to cold air makes it worse

Mild eczema

Family history of mother and cousins have asthma

Cough is occasionally triggered by laughing or crying.

Allergic Rhinitis

More nasal congestion since moving

Nose: Transverse nasal crease. 

Turbinates. Somewhat pale and edematous. Clear nasal secretions. No sinus tenderness when the frontal sinuses are palpated. No facial tenderness.

Cough for two months, associated with wheezing at night

Lungs: No evidence of retractions or a hyperinflated thorax. No changes to percussion or E-to-A changes. Normal I:E ratio. End-expiratory wheezing. No use of accessory muscles.

It is often worse at night, exposure to cold air makes it worse.

Cough is occasionally triggered by laughing or crying.

Chronic Sinusitis

More nasal congestion since moving

Nose: Transverse nasal crease. 

Turbinates. Somewhat pale and edematous. Clear nasal secretions. No sinus tenderness when the frontal sinuses are palpated. No facial tenderness.

Cough for two months, associated with wheezing at night

Lungs: No evidence of retractions or a hyperinflated thorax. No changes to percussion or E-to-A changes. Normal I:E ratio. End-expiratory wheezing. No use of accessory muscles.

It is often worse at night, exposure to cold air makes it worse.

Cough is occasionally triggered by laughing or crying.

Spirometry

Children older than five should undergo this test to show how well the lungs are functioning and if airway blockage is present and at least partially reversible

Complete blood count and chest X-ray

to rule out the likelihood of other illnesses, infections, and diagnoses

Allergy Test

The results of an allergy test may reveal a person's sensitivity to particular irritants (Cash & Glass, 2020).

Ventolin HFA MDI 90 /puff 2 puffs inhaled q4-6 hrs prn, quantity 1, refills 6

Short-acting B2 antagonist used as a bronchodilator for severe attacks. Onset is 2 to 5 minutes (Agabegi & Agebegi, 2020).

Bedesonide (Pulmicort Flexhaler) DPI: 90 mcg/inhalation 2 puffs inhaled BID, quantity 1, refills 6

Using corticosteroids to inhibit the immune system and decrease inflammation (Agabegi & Agebegi, 2020).

Educate on how to use spacers and inhalers properly.

Medication may not reach the bronchioles if the patient uses these devices improperly (Cash, Glass, & Mullen, 2021).

Educate family on triggers of asthma and ways to prevent triggers.

Learn how to avoid your triggers by being aware of them. Tobacco smoke, dust mites, air pollution, pests, mildew, inhaling chemicals, pets, exercise, scents, and food additives are a few examples of common triggers (Agabegi & Agebegi, 2020).

Educate Asthma action plan

The objective is to stop and manage asthma attacks. The three zones the National Institutes of Health developed should be included. The plan has three different colors: green when you're doing well, yellow when your asthma is becoming worse, and red when there is a medical emergency (Centers for Disease Control and Prevention, 2020).