Brian is a 7-year-old boy who presents to the primary care office with his mother

Brian is a 7-year-old boy who presents to the primary care office with his mother. His mom has noticed that Brian has been coughing frequently and seems to have shortness of breath at times. She reports that Brian had a “cold” with a low-grade fever and runny nose about 2 weeks ago and the symptoms seem to appear after the cold.

On physical examination, Brian appears in moderate respiratory distress, with suprasternal and intercostal retractions. His vital signs include a temperature of 100 Ax°F, a respiratory rate of 32 breaths per minute, heart rate of 120 beats per minute, and pulse oximetry of 95% on room air. The lung exam is notable for diffuse symmetrical expiratory wheezes. His nasal mucosa is erythematous with boggy turbinates and clear mucus. The remainder of the exam is unremarkable

1) Based on this case, discuss the differences in the pathophysiology for asthma vs pneumonia. 2) are there other differentials you would consider for this case and why? 3) What diagnostic tests would assist you in ruling a diagnosis in or out?

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