an 11-year-old boy with dry cough and respiratory distress (from children’s medical center grand rand)

The patient was an 11-year-old boy who was referred to our emergency department with a chief complaint of dry cough and shortness of breath. he was diagnosed with asthma when he was three years old and was treated with inhalers as needed. on physical examination, he had respiratory distress and biphasic wheezing. the patient was initially managed as an asthma attack; however, he did not respond to the treatment completely. after a pulmonology consult, he underwent a spirometry test, which was compatible with an obstructive pattern. he was a candidate for fiberoptic bronchoscopy, which revealed findings in favor of vocal cord dysfunction (vcd) and adult-onset laryngomalacia. as part of the management of vcd, we referred him to a psychiatric clinic, evaluating for psychological problems as aggravating factors. we found that he suffered from psychological disorders, including somatic symptoms disorders and mild to moderate depression. the patient was treated for his psychiatric problems. he responded to the treatment well, and the cough and dyspnea attacks resolved gradually after a few months.