Implications of persistent cough in a 3-year-old female

Abstract

HISTORY OF PRESENTING ILLNESS A 3-year-old female was seen by a family physician for daily, persistent nonproductive cough for the past 6 months. Vigorous activity or upper respiratory infections did not provoke the cough; seasonal changes did not alter its frequency. It did occasionally worsen at night. Although there was no complaint of wheezing or dyspnea, use of an albuterol inhaler helped somewhat, but not always. The patient did not complain of any nasal symptoms. The mother did not recall any past choking episodes to suggest ingestion of a foreign body. A diagnosis of mild persistent asthma based on clinical presentation was made and she was empirically started on albuterol metered-dose inhaler as needed, and beclomethasone dipropionate 42 g, three puffs, twice daily. She had never received oral or intravenous steroids, nor had she been hospitalized. Other medications included cetirizine syrup 2.5 mg nightly and mometasone nasal inhaler one spray each nostril nightly. Further questioning revealed occasional episodes of a “fast heartbeat,” excessive sweating, and persistent hoarseness.