The Differential Diagnosis of Asthma in Childhood
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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.
KeywordsCystic Fibrosis Allergic Rhinitis Esophageal Atresia Bronchiolitis Obliterans Tracheoesophageal Fistula
- 3.Koneg P. Diagnostic problems in asthma. Ann Allergy 1985; 55: 95–103.Google Scholar
- 4.Smith L. Childhood asthma: diagnosis and treatment. Curr Prob Pediatr 1993; 23: 271–305.Google Scholar
- 5.Richards W. Differential diagnosis of childhood asthma. Curr Prob Pediatr 1974; 4: 3–36.Google Scholar
- 8.Karem E, Reisman J, Corey M, et al. Wheezing in infants with cystic fibrosis: clinical course, pulmonary function, and survival amalysis. Pediatrics 1992; 90: 703–706.Google Scholar
- 16.Barrington KG, Finer NN. Treatment of bronchopulmonary dysplasia. A review. Clin Perinatol 1998; 25: 177–202.Google Scholar
- 19.Wood RP, Milgrom H. Vocal cord dysfunction. JACI 1996; 98: 481–485.Google Scholar
- 20.Bierman CW, Pearlman DS. Asthma, in Kendig’s Disorders of the Respiratory Tract in Children, 5th ed. ( Chernick, V, ed.), WB Saunders, Philadelphia, 1990; pp. 576.Google Scholar