Case Presentation :

• A 32-year-old female presented to the outpatient department with complaints of progressive shortness of breath, initially on exertion and later at rest (mMRC Grade II), intermittent wheezing and episodic chest tightness, particularly at night and early morning.
• The patient reported that symptoms began 6 days prior with mild cough, which progressively worsened in frequency and sputum production. The sputum was mucoid, non-purulent, and not blood-stained.
• No history of fever, hemoptysis, orthopnea, or paroxysmal nocturnal dyspnea
• No recent upper respiratory tract infection

Past Medical History :

• Known case of Asthma for 5 years
• History suggestive of poor adherence to inhaled corticosteroid therapy

Family History :

• Mother diagnosed with bronchial asthma

General Examination :

• Pulse: 96/min
• Respiratory rate: 22/min
• Blood pressure: 118/76 mmHg
• SpO₂: 95% on room air

Respiratory Examination

• Auscultation:

1. Diffuse bilateral expiratory wheeze
2. Scattered rhonchi

Investigations

• Complete Blood Count (CBC): Mild eosinophilia
• Sputum Examination:

1. Mucoid sputum
2. No bacterial pathogens
3. Occasional eosinophils

• Chest X-ray:

1. Hyperinflated lung fields
2. Flattened diaphragms
3. No focal consolidation or effusion

Diagnosis :

• Bronchial Asthma with Mucus Hypersecretion

Management :

• The patient was initiated on combination therapy of Terbutaline, Guaifenesin and Bromhexine.
• Steam inhalation to aid mucus clearance
• Adequate hydration

At 2-week follow-up :

• Patient achieved good symptom control
• No adverse drug reactions reported
• Maintenance therapy with inhaled corticosteroids was reinforced