Of course you have asthma: Persistent wheezing

Case presentation

An 8-year-old boy presents with 3 days of cough, fever, and headache. He had been seen the previous day by his primary care physician and he was told to come to the Emergency Department after a chest x-ray performed as an outpatient demonstrated findings concerning for pneumonia. Six weeks ago, he was diagnosed with a right lower lobe pneumonia and treated with oral amoxicillin but failed to clinically improve and was admitted to the hospital for further management. He improved clinically and was discharged to complete a course of oral antibiotics.

Medical history is notable for a diagnosis of reactive airway disease at 3 years of age, which mostly responded to treatment with bronchodilators. His mother observed that he seemed to have more breathing problems over the last 3 years, and he was diagnosed as an outpatient multiple times over this time period with clinical pneumonia and “bronchitis.”

Physical examination reveals a nontoxic child whose only complaint is right-sided chest pain with deep inspiration. His vital signs demonstrate a temperature of 102 degrees Fahrenheit, a heart rate of 130 beats per minute, a respiratory rate of 24 breaths per minute, a blood pressure of 127/68 mm Hg, and a pulse oximetry reading of 95% on room air. He has an unremarkable examination other than his pulmonary exam, which has decreased breath sounds on the right without crackles or rhonchi, but there is mild inspiratory and expiratory wheezing; he has no retractions or grunting.

Imaging considerations