PRESENTING FELLOWSa'ad Al-Otaibi, MD
Pediatric Pulmonary Fellow, Alberta Children's Hospital
Calgary, Alberta, Canada.
CASE PRESENTATIONA 14-year-old girl was referred to the Asthma Clinic by her family doctor. She complained of shortness of breath and a chronic dry cough since infancy. Her symptoms were exacerbated by exercise. She complained of nocturnal cough and difficulty breathing. There was no history of snoring or apnea. She was diagnosed with asthma when she was 7 years old. However, she was not responding to well administered high dose inhaled asthma treatments. (Flovent, Ventolin). She was allergic to cats, horses, trees and grass. She was not involved in any sports because of her exercise intolerance.
Systemic review was unremarkable. Family history revealed asthma and hay fever in her father. Her brother has hay fever. There is no history of unusual environmental exposures, nor of weight loss or night sweats. Pregnancy and birth history were uneventful. She had normal growth and development.
PAST HISTORYShe was seen in the Infectious Disease clinic when she was 8 years old with persistent sore throat, dry cough, nasal congestion and intermittent abdominal pain. These had been episodic in nature since she was 3 years old. Throat cultures were negative for group A streptococcus. She received multiple antibiotic courses with no relief. A lateral neck x-ray at that time was normal. Anti gastro-oesophageal reflux medical treatment was attempted with no improvement. She was treated with salbutamol. There was no history of hospital admissions nor emergency visits for acute exacerbations of asthma and no history of systemic steroid therapy.
On examination she was an intelligent, friendly, thin young girl.
Her vital signs were stable.
Her weight was at the 60th% and her height was at the30th%.
Ear, nose and throat exam was normal.
There were no polyps or signs of inflammation.
There was neither lymphadenopathy nor clubbing.
Chest examination revealed a barrel chest (increased A-P diameter), and breath sounds were decreased anteriorly.
There were no added adventitial sounds.
The cardiovascular exam revealed muffled heart sounds.
There were no murmurs and there were no signs of heart failure.
Her abdominal exam was normal as well as the rest of the physical exam.
INVESTIGATIONShe had a Pulmonary Function test.
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