Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- wheezing episode triggers
- increased work of breathing
- features of atopic disease
- history of response to treatment within appropriate time frame
Other diagnostic factors
- age >3 years
- dry night-time cough
- dyspnoea on exertion
- expiratory wheezing
- chest wall deformity
Risk factors
- allergic sensitisation
- atopic disease
- wheezing triggered by non-viral/non-allergic environmental factors
- respiratory viral infections in early life
- serum eosinophilia (4% or greater)
- family history of asthma
- passive or active tobacco smoking
- abnormal lung function and airway hyper-responsiveness
- outdoor air pollution
- female sex
- obesity
- acid-suppressive drug use in pregnancy
Diagnostic investigations
1st investigations to order
- spirometry
- response to bronchodilator on spirometry
- chest x-ray
Investigations to consider
- peak expiratory flow rate (PEFR)
- airway challenge tests
- exercise challenge test
- FBC
- bronchoscopy
- sweat test
- sputum culture
- electron micrograph ciliary studies
- skin prick testing
- fractional expired nitric oxide (FeNO)
- bronchoalveolar lavage
Treatment algorithm
age 0 to 5 years
age 6 to 11 years
Contributors
Authors
Paul D. Robinson, MBChB, MRCPCH, FRACP, PhD
Respiratory and Sleep Physician
The Children's Hospital at Westmead
Clinical Professor
Discipline of Paediatrics and Child Health
Sydney Medical School
University of Sydney
Sydney
New South Wales
Australia
Disclosures
PDR declares that he has no competing interests.
Anne Chang, MBBS, FRACP, MPHTM, PhD, FAPSR, FThorSoc, FAHMS
Professor
Respiratory and Sleep Physician
Queensland Children's Hospital
Queensland University of Technology
Brisbane
Menzies School of Health Research
Charles Darwin University
Darwin
Australia
Disclosures
AC's institution has received fees from her work on the independent data monitoring committee board for an unlicensed vaccine (GSK) and as an advisory member of study design for an unlicensed molecule for chronic cough (Merck), outside the work for this topic. AC has received fees from UpToDate for writing chapters on cough in children. She is an author of a number of references cited in this topic.
Peer reviewers
Chris Cates, MA, FRCGP
Senior Clinical Research Fellow
Community Health Sciences
St. George's University of London
London
UK
Disclosures
CC is an author of a number of references cited in this topic.
Peter Griffiths, MBChB
General Practitioner
Harborne Medical Practice
Birmingham
UK
Disclosures
PG declares that he has no competing interests.
Karin A. Pacheco, MD, MSPH
Assistant Professor
Division of Environmental & Occupational Health Sciences
National Jewish Health
Denver
CO
Disclosures
KAP declares that she has no competing interests.
Ware Kuschner, MD
Associate Professor of Medicine
Stanford University
Stanford
Staff Physician
US Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto
CA
Disclosures
WK declares that he has no competing interests.
Differentials
- Bronchiolitis
- Episodic (viral) wheeze
- Inhaled foreign body
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