A child with chronic cough and malabsorption or failure to thrive should be evaluated for which disease?

• A. Pneumonia
• B. Cystic fibrosis
• C. Asthma
• D. Bronchitis

Answer: (B)

Chronic cough with malabsorption or failure to thrive points to a multisystem disease that affects both the airways and the digestive tract, most classically cystic fibrosis. The underlying defect causes very thick mucus that blocks airways, leading to persistent cough and recurrent respiratory infections, while also obstructing pancreatic ducts and causing pancreatic exocrine insufficiency with fat malabsorption and poor weight gain. This combination of pulmonary disease and malabsorption is characteristic and should prompt specific testing. Evaluation typically includes a sweat chloride test (high chloride supports CF), genetic testing for CFTR mutations, and assessment of pancreatic function such as stool elastase. While pneumonia, asthma, or bronchitis can cause cough, they do not inherently explain concurrent malabsorption and failure to thrive.