The Differential Diagnosis of Asthma in Childhood

  • Gary A. Incaudo


  • Growth, development, and psychosocial ambiance add to the complexity when evaluating respiratory problems from the neonatal period to late adolescence.

  • Cough and wheezing are among the most common health care complaints in childhood. Asthma is, by far, the most common source of wheezing in this age group.

  • The suspicion of an alternative diagnosis beyond asthma is heightened in the wheezing infant less than six months of age.

  • The incidence of wheezing induced by allergically mediated disease increases progressively after age 2 years.

  • Allergic rhinitis, sinusitis, and sinobronchitis are the most frequently missed diagnoses in wheezing children who are historically unresponsive or poorly responsive to bronchodilator and antiinflammatory therapy.

  • Exercise induced asthma is primarily a disease of adolescence. Its existence outside of this time period suggests an alternative or concurrent diagnosis influencing the asthmatic expression.

  • In a wheezing child, the correct diagnosis is usually made through the history and by observing the child’s breathing pattern during the interview. Physical findings typically substantiate that diagnosis.

  • Wheezing which reproducibly responds to bronchodilator therapy suggests a diagnosis of asthma but does not rule out additional aggravating medical problems. All precipitating sources must be identified before the diagnosis of asthma is complete.

  • Every child with wheezing, regardless of the age of onset, frequency, or perceived precipitin, should have a minimum of one chest x-ray on record; the results of which are available to the examiner for review.

  • A sweat chloride test should be performed in all children under the age of one year with recurrent wheezing and all children with persistent wheezing.

  • Adolescents and young adults hyperventilate.

  • Gastroesophageal reflux as a source of wheezing or wheezing exacerbation in all age groups has been under-diagnosed in the past and should now be increasingly recognized and appreciated.


Cystic Fibrosis Allergic Rhinitis Esophageal Atresia Bronchiolitis Obliterans Tracheoesophageal Fistula 
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© Springer Science+Business Media New York 2001

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  • Gary A. Incaudo

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