1. Chronic Productive Cough Dr. Miao Shang Su

2. Present History - A 5-year-old girl come to your clinic for the first time. Her mother reports that the child has a productive cough for the past 6 months, and fever for 2 days. - The girl has a history of asthma for which she uses a steroid inhaler every day as well, and an albuterol inhaler as needed.

3. - The child has also been given various over- the–counter cold and allergy remedies, but despite all of her medications, her symptoms have been worsening over the past several months. - The mother reports that her daughter was treated for sinusitis during each of the past two winter seasons, and that she has always be nasal discharge.

4. - There was occasionally chest pain and hemoptysis during exacerbation. - There was unexpected neonatal respiratory distress in a term baby. - There no history of palpitation, regurgitation, vomiting, gastrointestinal bleed, contact with tuberculosis. - There was no apparent genetic diseases in the family.

5. Physical examination - His weight and height are at the 5th percentile for age, her temperature is 38.3 °C orally, and her respiratory rate is 32 breaths per minute. - She has scant purulent rhinorrhea from both nostrils. Her breath sounds are wheezy in all lung fields and diminished on the right side. Heart sounds and capillary refill are normal, yet she has digital clubbing

6. Question What is the diagnosis of this case? How to make the differential diagnosis ? How to further investigate and treat this disease ?