Cystic fibrosis and primary ciliary dyskinesia Quiz: Ace Your Exams

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An 8-year-old boy presents to a pulmonologist for evaluation of a chronic productive cough, congestion, recurrent respiratory infections, and recurrent otitis media. Parents report the patient has been sick much more often than his peers. He was born full-term but did spend time in the NICU for respiratory distress. He is up to date on all vaccinations including influenza, COVID-19, and pneumococcal 13-valent conjugate vaccine (PCV13). He is at the 23rd percentile for height and the 12th percentile for weight. Temperature is 37.3°C (99.1 F), pulse is 104/min, respirations are 22/min, blood pressure is 106/68 mmHg, and oxygen saturation is 98%. Head and neck examination shows bilateral middle ear effusions, nasal congestion, and polyps. Heart rate is regular, and no murmur is appreciated. Diffuse rhonchi are heard without increased work of breathing. The patient undergoes a full work-up. Nitrous oxide is found to be very low, and a genetic pulmonary disease is confirmed. Which of the following interventions is recommended?

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