A 7-Year-Old Boy with Productive Cough, Wheezing, & Chest Congestion

Case Presentation :

A 7-year-old male child was presented to the pediatric outpatient department with chief complaint of:

  • Productive cough for 10 days
  • Wheezing for 5 days
  • Chest congestion
  • Breathlessness during exertion
  • Disturbed sleep due to nocturnal cough
  • Fatigue and reduced physical activity

The patient had a known history of recurrent episodes of asthma over the previous 2 years, characterized by episodic wheezing and cough, particularly during seasonal changes and following upper respiratory tract infection.

Past Medical History :

  • Recurrent respiratory infections
  • On intermittent bronchodilator therapy, no regular inhaled corticosteroid (ICS) maintenance therapy was given
  • No prior hospitalization requiring ICU admission
  • Immunization status up to date

Family History :

  • Family history revealed allergic rhinitis in the mother, suggesting an atopic predisposition.

Clinical Examination :

  • Mildly irritable due to persistent cough and breathing discomfort.
  • Productive cough with expectoration of thick, whitish mucoid sputum.
  • Mild clear-to-mucoid nasal discharge.

Respiratory Examination

  • Coarse crackles/rhonchi predominantly in bilateral basal regions.
  • Prolonged expiratory phase suggestive of bronchial obstruction.
  • Reduced air entry in mucus-congested areas.
  • Intermittent harsh breath sounds.
  • FEV1 was found to be decreased
  • FEV1/FVC ratio decreased
  • PEFR was lower than normal

Diagnosis and Severity Assessment:

  • Asthmatic Bronchitis.
  • Severity Assessment: Moderate persistent asthma as per GINA-based clinical severity assessment.

Management :

  • Controller therapy (ICS) with Formoterol was advised for long-term asthma management after acute symptom control
  • Add on treatment was started with a combination therapy consisting of Guaifenesin + Ambroxol + Terbutaline orally in Syrup formulation.
  • The patient was advised to take the Syrup 5-10 ml thrice daily.

Adjunctive Therapy

  • Nebulization was reserved only for acute worsening (not recommended for routinely use).
  • Hydration and steam inhalation.
  • Monitoring of respiratory symptoms.

Clinical Outcomes

  • Marked reduction in frequency and severity of productive cough.
  • Significant decrease in wheezing episodes.
  • Relief from chest congestion and chest tightness.
  • Resolution of nocturnal cough and sleep disturbance.
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