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Endgames Case Report

An asthmatic child with a troublesome cough

BMJ 2011; 342 doi: (Published 02 February 2011) Cite this as: BMJ 2011;342:c6846
  1. Steve Turner, senior clinical lecturer in child health
  1. 1Royal Aberdeen Children’s Hospital, University of Aberdeen, Foresterhill, Aberdeen, UK
  1. Correspondence to: S Turner s.w.turner{at}

A 12 year old girl with an eight year history of asthma presented to her family doctor for the third time in four weeks with ongoing, troublesome, non-productive cough. The cough was described as “coming on in fits” and was disturbing her sleep. By day, the cough could be brought on by exercise or breathing in cold air but sometimes came on “out of the blue.” Once or twice a day, the cough would induce retching, and she had vomited on occasion. Over the past month she had been prescribed five days of prednisolone and a week’s worth of clarithromycin, and a long acting beta agonist had been added to her low dose inhaled steroid, all to no effect. She had no history of wheezing, and the only history of shortness of breath was during the coughing.

She had two hospital admissions for asthma at ages 6 and 7 and her attendance at the practice asthma clinic had been good. She also had eczema and mild hay fever. Her mother had asthma and was a regular smoker. Her immunisations were all up to date. Examination was normal aside from a right sided subconjunctival haematoma.


  • 1 What is the most likely diagnosis?

  • 2 What investigations, if any, are appropriate?

  • 3 What is the next management step?

  • 4 How long will these …

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