Case history
Case history #1
An 8-year-old boy presents with intermittent wheeze and cough, and with a history of asthma. Over recent months he has had problems with nighttime wheeze and shortness of breath. He is waking at least 3 or 4 nights per week since recovering from an upper respiratory tract infection. He requires his short-acting beta agonist metered-dose inhaler (MDI) to enable him to get back to sleep. He has also noted more problems with wheeze and shortness of breath on minimal playing at school. His primary care physician has tried a leukotriene receptor antagonist in the past, but currently he is managed with a short-acting beta agonist as required. He now needs a new short-acting beta agonist MDI every 2 to 3 weeks.
Case history #2
A 3-year-old girl presents with a history of episodes of wheeze and troublesome cough over the past 2 years. These episodes are more common through the winter months. On two occasions she has been given oral corticosteroids because of severe wheeze, which was relatively unresponsive to a short-acting beta agonist given via MDI. In the past 6 months she has had monthly episodes of wheezing with shortness of breath, and two of these have resulted in the need for frequent short-acting beta agonist. At present she is using a short-acting beta agonist as required, but has used inhaled corticosteroids during the attacks in the past. Between these episodes she is well, although her mother has noted some wheeze after vigorous playing. Her father has asthma and the child herself has eczema.
Other presentations
Children may present with episodes of recurrent cough. These episodes may be triggered by viral infections, change in weather, or exercise. The cough is typically dry in nature and only occasionally associated with an audible wheeze. Closer questioning may reveal the predominant trigger and a feeling of chest tightness and difficulty breathing accompanying the cough. A short-acting beta agonist MDI typically provides relief.
Use of this content is subject to our disclaimer