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:
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