Diagnosis and treatment for a child's cough?

MEDICAL ASSESSMENT

Ang batang ito ay may acute bronchitis na post-viral, at hindi kailangan ng salbutamol dahil walang ebidensya ng asthma o wheezing—ang tamang approach ay symptomatic treatment lamang at patient education tungkol sa expected duration ng ubo na 2-3 linggo. 1

Diagnosis

Acute Bronchitis (Post-viral)

Ang 9-year-old male ay may classic presentation ng acute bronchitis: 4 days na productive cough na may whitish phlegm, recent onset ng lagnat, at walang specific cough pointers na nagsusuggest ng mas seryosong kondisyon. 1 Ang non-specific cough na ito ay karaniwang post-viral at acute bronchitis, na self-limiting condition. 1

Key Clinical Points:

• Walang mention ng wheezing, difficulty breathing, o history ng recurrent episodes na magsusuggest ng asthma 1
• Ang whitish phlegm ay normal sa viral infection at hindi indicator ng bacterial infection 2, 3
• Ang 4-day duration ay consistent pa rin sa acute phase ng viral bronchitis 2, 3

Plan and Recommendations

Medication (PhilHealth Konsulta Formulary-compliant, <300 pesos):

1. Paracetamol 250mg tablet

• Dose: 1 tablet every 6 hours as needed for fever/pain
• Dispense: 20 tablets
• Duration: 5 days
• Para sa lagnat at body aches 4

2. Lagundi (Vitex negundo) syrup 300mg/5mL

• Dose: 10mL (2 teaspoons) three times daily
• Dispense: 1 bottle (120mL)
• Duration: 5-7 days
• Para sa symptomatic relief ng ubo 4

HINDI KAILANGAN ANG SALBUTAMOL dahil walang clinical evidence ng bronchospasm, wheezing, o asthma. Ang salbutamol ay bronchodilator na specifically para sa asthma o reactive airway disease, hindi para sa simple viral bronchitis. 1, 5

Non-Pharmacologic Management:

• Maraming tubig at fluids 4
• Rest at avoid strenuous activities 4
• Avoid exposure sa smoke at pollutants 1

Follow-up Instructions:

• Review in 1-2 weeks kung hindi bumubuti ang ubo 1
• Bumalik agad kung may: difficulty breathing, persistent high fever >3 days, chest pain, o kung lumalala ang symptoms 1
• Kung ang ubo ay tumatagal ng >3 weeks, kailangan ng re-evaluation para sa post-infectious cough 4, 6

Patient/Parent Education

Ang acute bronchitis ay viral infection na self-limiting. Ang ubo ay normal na tumatagal ng 2-3 linggo kahit walang gamot. 4, 2, 3 Hindi kailangan ng antibiotics dahil viral ang infection, hindi bacterial. 4, 2, 3 Ang whitish phlegm ay normal sa viral infection at hindi sign ng bacterial infection na nangangailangan ng antibiotics. 2, 3

Ang salbutamol ay hindi appropriate dahil ito ay para lamang sa mga batang may asthma o wheezing, na wala sa kasong ito. 1, 5

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MEDICAL CERTIFICATE

This certifies that patient has been seen and examined today with the diagnosis of:

Acute Bronchitis (Post-viral)

and recommendation of:

Home rest, adequate hydration, symptomatic treatment with paracetamol for fever as needed and lagundi syrup for cough relief. Expected duration of cough is 2-3 weeks. Follow-up in 1-2 weeks if symptoms persist or worsen. Return immediately if difficulty breathing, persistent high fever, or worsening symptoms develop.

This medical certificate is issued upon the request of the patient for: (to be filled in based on patient's specific need)