Pediatrician office with complaints of dyspnea and wheezing


Problem:

A 14 year old girl, Annette, enters the Pediatrician's office with complaints of dyspnea, wheezing, and chest tightness. The history of the illness from the family includes: A recent upper respiratory infection with cough, congestion and runny nose with a low grade fever of 100.8 degrees Fahrenheit. Mother also states this has happened the last few times Annette had cold symptoms and does seem to get relief from Albuterol that was prescribed previously. Annie is behind on her well checks and usually only comes in for sick visits. Family/Social History Family history revealed that mother has asthma and because of this uses a lot of hand sanitizer for herself and family to keep them from "catching colds". In the home lives Annette, her mother, father and little brother age 6. Annette's father is a smoker but mother states he smokes outside. The family is living in a home currently under renovations. Upon assessment Annie has the following: intermittent coughing expiratory wheezing subcostal retractions temperature of 100.8 PO heart rate of 100 bpm respiratory rate of 40 pulse oximetry 92 % purulent mucous from bilateral nares catching her breath often while speaking What are three differentiate diagnoses? Please provide the rationale.

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