Abstract
-
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.
Chapter PDF
Similar content being viewed by others
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
References
Strachan DP. Prevalence and natural history of wheezing in early childhood. J R Coll Gen Pract 1985; 35: 182–184.
Boner MLC, Boner AL. Clinical diagnosis of wheezing in early childhood. Allergy 1995; 50: 701–710.
Koneg P. Diagnostic problems in asthma. Ann Allergy 1985; 55: 95–103.
Smith L. Childhood asthma: diagnosis and treatment. Curr Prob Pediatr 1993; 23: 271–305.
Richards W. Differential diagnosis of childhood asthma. Curr Prob Pediatr 1974; 4: 3–36.
Goldenhersh MJ, Rachelefsky GS. Childhood asthma: overview. Pediatr Rev 1989; 10: 227–234.
Roback MG, Dreitlein DA. Chest radiograph in the evaluation of first time wheezing episodes: review of current clinical practice and efficacy. Pediatr Emerg Care 1998; 14: 181–184.
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.
Benedetti M, Valletta EA, Marradi P, Boner AL. Problemi diagnostici in un bambino di 7 mesi con lobite tuberculcolare. Pediatr Med Chir 1993; 15: 517–519.
Landing BH, Dixon DG, Congenital malformations and genetic disorders of the respiratory tract. Amer Rev Resp Dis 1979; 120: 151–182.
Oermann CM, Moore RH. Foolers: things that look like pneumonia in children. Semin Respir Infect 1996; 11: 204–213.
Godfrey S. Bronchiolitis and asthma in infancy and early childhood. Thorax 1996; 51 (Suppl 2): S60 - S64.
Pullen CR, Hey EN. Wheezing, asthma, and pulmonary dysfunction 10 years after infection with respiratory syncytial virus in infancy. BMJ 1982; 284: 1665–1669.
Baharloo F, Veyckemans F, Francis C, et al. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest 1999; 115: 1357–1362.
Silva AB, Muntz HR, Clary R. Utility of conventional radiography in the diagnosis and management of pediatric airway foreign bodies. Ann Otol Rhinol Laryngol 1998; 107: 834–838.
Barrington KG, Finer NN. Treatment of bronchopulmonary dysplasia. A review. Clin Perinatol 1998; 25: 177–202.
Bruno G, Graf U, Andreozzi P. Gastric asthma: an unrecognized disease with an unsuspected frequency. J Asthma 1999; 36: 315–321.
Theodoropoulos DS, Lockey RF, Boyce HW Jr, Bukantz SC. Gastroesophageal reflux and asthma: a review of the pathogenesis, diagnosis, and therapy. Allergy 1999; 54: 651–661.
Wood RP, Milgrom H. Vocal cord dysfunction. JACI 1996; 98: 481–485.
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.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2001 Springer Science+Business Media New York
About this chapter
Cite this chapter
Incaudo, G.A. (2001). The Differential Diagnosis of Asthma in Childhood. In: Gershwin, M.E., Albertson, T.E. (eds) Bronchial Asthma. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-127-5_5
Download citation
DOI: https://doi.org/10.1007/978-1-59259-127-5_5
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-4757-4687-7
Online ISBN: 978-1-59259-127-5
eBook Packages: Springer Book Archive