Asthma: The Daily PANCE Blueprint
A 6-year-old girl is brought in for evaluation of a persistent dry cough lasting for 3 months. The cough is particularly troublesome at night, causing frequent awakenings and has also been noted to occur during physical activities such as running or playing outside. The child has no fever, rhinorrhea, or history of recent illnesses. She has been using a humidifier at night without improvement. Her parents report no significant medical history or use of chronic medications. Physical examination reveals clear lung sounds, and her vital signs are within normal limits. Height and weight are at the 40th percentile. What is the most appropriate next step in the evaluation of this patient?
A. Trial of inhaled corticosteroids
B. Empiric treatment with antibiotics
C. Chest X-ray
D. Spirometry with bronchodilator response
E. Allergy testing
Answer and topic summary
The answer is D. Spirometry with bronchodilator response
Chronic cough in children that worsens at night and during physical activity can often be attributed to asthma, especially in the absence of other symptoms like fever or rhinorrhea. Spirometry with bronchodilator response is an appropriate next step to assess lung function and response to bronchodilators, which can help confirm a diagnosis of asthma. The child’s history of nighttime symptoms and cough during exertion are classic signs of asthma, and spirometry can objectively measure airway obstruction.
Incorrect Answers:
- A. Trial of inhaled corticosteroids – While this could be part of the management if asthma is diagnosed, confirming the diagnosis with objective measures like spirometry is a better initial step.
- B. Empiric treatment with antibiotics – There are no signs of infection (such as fever or productive cough) to warrant antibiotic therapy.
- C. Chest X-ray – This is generally not indicated as a first step in evaluating a child with a chronic dry cough and no signs of infection or physical abnormalities on examination. It may be considered if other symptoms arise that suggest a different diagnosis.
- E. Allergy testing – This could be relevant if allergic triggers are suspected, but in this case, the history strongly suggests asthma as a primary concern, which should be evaluated first with spirometry.
Source: UpToDate (approach to chronic cough in children)
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Pulmonary ⇒ ⇒
