Asthma and COPD Q 45

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A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following?

  

     A. Acute asthma

     B. Bronchial pneumonia

     C. Chronic obstructive pulmonary disease (COPD)

     D. Emphysema

    

    

Correct Answer: A. Acute asthma

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Based on the client’s history and symptoms, acute asthma is the most likely diagnosis. Patients will usually give a history of a wheeze or a cough, exacerbated by allergies, exercise, and cold. There is often diurnal variation, with symptoms being worse at night. Many asthmatics have nocturnal coughing spells but appear normal in the daytime. He’s unlikely to have bronchial pneumonia without a productive cough and fever and he’s too young to have developed COPD or emphysema.

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Option B: Recurrent episodes of acute shortness of breath, typically occurring at night or in the early morning hours, are the cardinal manifestation of bronchial asthma. Further symptoms include cough, wheezing, and a feeling of tightness in the chest. Auscultation of the chest reveals rales, rhonchi, and wheezes.

Option C: It is associated with structural lung changes due to chronic inflammation from prolonged exposure to noxious particles or gases most commonly cigarette smoke. Chronic inflammation causes airway narrowing and decreased lung recoil. Patients usually present with complaints of chronic and progressive dyspnea, cough, and sputum production. Patients may also have wheezing and chest tightness.

Option D: Most patients present with very nonspecific symptoms of chronic shortness of breath and cough with or without sputum production. As the disease process advances, the shortness of breath and cough progressively gets worse. Initially, there is exertional dyspnea with significant physical activity, especially arm work at or above shoulder level with progression to dyspnea with simple daily activities and even at rest. Some patients may present with wheezing because of the airflow obstruction.

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