Joey has a history of asthma which appears to be well-controlled with the use of his maintenance inhaler and as needed rescue inhaler. He presents now with a 2 week history of a cough. There is no mention of a fever or that this cough has limited his activities except for low energy. There is no mention that this cough is productive or non-productive. If there is sputum production, what is the color and consistency of it - is it clear, white, yellow, green or rust colored. I would be concerned that his acute cough could be attributed to several things: new onset pneumonia, bronchitis, an upper respiratory infection, or that his asthma is not as well controlled as it should be. His asthma predisposes him to airway illnesses. I would be looking for any signs and symptoms of post nasal drainage from his nose, ear pain or throat pain to see if it is a simple resolving cold. However, since these symptoms have been persistant for two weeks, it is something that likely will need medications.

In other individuals, an acute cough could be a sign of an exacerbation of congestive heart failure, pulmonary embolus, pulmonary edema, irregular heart rhythm, pulmonary fibrosis, or even a heart attack.

A chronic cough is likely due to persistant post nasal drainage, asthma, and also gastric reflux disease (GERD). Many asthmatics tend to have a history of both GERD and asthma. Chronic coughing is also a symptom of chronic bronchitis attributed to current or past smoking by patients.

Joey's diagnosis of bacterial pneumonia is concerning becuase his grandmother has a chronic health condition of COPD. Her compromised immune system makes her at risk for exposure as well as advanced age. Despite good hand washing techniques, disposal of used tissues, and vaccination of the pneumonia vaccine, the bacteria is air borne and she has possibly been exposed to it the past two weeks. There is no information to determine if Joey's grandmother still smokes. Smokers tend to harbor more bacteria in their lungs which make them at higher risk for lung infections. The dead space in the lungs of someone with COPD may be filled easier with infection. Thus, I would advise Joey's mother to have the grandmother check with her healthcare provider to see what followup they would feel is important since she has had this exposure.

References

McCance, K. L. & Huether, S.E. (2006) Pathophysiology: The biologic basis for disease in adults and children (5th edition, 1205-1248).

McPhee, S.J. & Ganong, W.F. (2006) Pathophysiology of Disease: An introduction to Clinical Medicine (5th edition, 218-258).

Kumar, V., Abbas A. K. & Fausto, N. (2005) Pathologic Basis of Disease (7th edition, 711-772).