clinical clues to alternative diagnoses in wheezy children
Last reviewed 01/2018
Clinical clues to alternative diagnoses in wheezy children (features not commonly found in children with asthma)
| Perinatal and family history | Possible diagnosis |
| Symptoms present from birth or perinatal lung problem | Cystic fibrosis; chronic lung disease of prematurity; ciliary dyskinesia; developmental anomaly |
| Family history of unusual chest disease | Cystic fibrosis; neuromuscular disorder |
| Severe upper respiratory tract disease | Defect of host defence; ciliary dyskinesia |
| Symptoms and signs | |
| Persistent moist cough | Cystic fibrosis; bronchiectasis; protracted bronchitis; recurrent aspiration; host defence disorder; ciliary dyskinesia |
| Excessive vomiting | Gastro-oesophageal refl ux (+/- aspiration) |
| Dysphagia | Swallowing problems (+/- aspiration) |
| Breathlessness with light-headedness and peripheral tingling | Hyperventilation/panic attacks |
| Inspiratory stridor | Tracheal or laryngeal disorder |
| Abnormal voice or cry | Laryngeal problem |
| Focal signs in chest | Developmental anomaly; post-infective syndrome; bronchiectasis; tuberculosis |
| Finger clubbing | Cystic fibrosis; bronchiectasis |
| Failure to thrive | Cystic fibrosis; host defence disorder; gastro-oesophageal reflux |
| Investigations | |
| Focal or persistent radiological changes | Developmental anomaly; cystic fibrosis; post-infective disorder; recurrent aspiration; inhaled foreign body; bronchiectasis; tuberculosis |
Reference:
- (1) BTS/SIGN (May 2008). British Guideline on the Management of Asthma.