A 3½-year-old boy has experienced three episodes of right upper lobe pneumonia in the past 6 months,most recently 3 weeks ago. Since the age of 15 months, the child has had frequent episodes of bronchitis and purulent rhinitis that involved fever and were treated with oral antibiotics, inhaled bronchodilators,and intranasal and inhaled corticosteroids. Because of persistent nasal obstruction, he underwent adenoidectomy without improvement. There is no family history of asthma.

Physical examination reveals a friendly boy whose weight and height are in the 75th percentile. The only abnormal finding is nasal congestion. There is no dullness or hyperresonance on chest percussion, and auscultation does not identify prolonged expiration or diminished or abnormal breath sounds. No digital clubbing is present.

Previous chest roentgenograms showed right upper lobe consolidation with air bronchogram and almost complete resolution between episodes of pneumonia as well as persistently accentuated bronchovascular markings in all lung fields. Laboratory...

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