Diagnosis | Key clinical features | Tests |
Wheeze in the first year of life | Likely viral or bacterial triggers | Nasopharyngeal aspirate |
Episodic (viral) wheeze | Clear history of viral trigger | Thorough history and examination. Exclusion of other likely diagnoses |
Multitrigger wheeze | Presence of interval symptoms as well as triggers other than viral infections Strong family history of atopy | Thorough history and examination. Skin prick testing may be useful in Multitrigger wheeze |
Viral infection | Features of bronchiolitis—coryza, hyperinflation and basal crackles | Nasopharyngeal aspirate for immunofluoresence, PCR or viral culture |
Gastro-oesophageal reflux with or without aspiration | Vomiting or poor weight gain. Symptoms such as coughing, mouth, gagging when lying flat raises suspicion | 24 hours impedance and pH study. Contrast swallow, bronchoscopy for lipid laden macrophages |
Inhaled foreign body | Prior episode of coughing or choking (not always present). Chronic cough | An inspiratory and expiratory chest radiograph when patient presents acutely can be difficult to perform in preschool age group, a decubitus film may be helpful34; a history of a witnessed choking episode combined with a sudden onset of respiratory symptoms remains the most important indication for bronchoscopy. To confirm and remove foreign body |
Immune deficiency | Wheeze with infections which are severe, persistent, unusual or recurrent | Immunoglobulins, functional antibodies and T and B cells |
Cystic fibrosis | Cough in the first weeks of life. Chronic diarrhoea due to malabsorption leading to faltering growth (if pancreatic insufficient) | Most cases identified are now by newborn screening. Sweat test |
Primary ciliary dyskinesia | Chronically discharging ears and persistent and/or early-onset (first few weeks of life) rhinorrhoea | Chest radiograph to look for dextrocardia (present in 50%). Ciliary studies |
Tracheomalacia/bronchomalacia | History of trachea-oesophageal atresia and oesophageal atresia, harsh, monophonic expiratory noise or noisy breathing | Flexible bronchoscopy |
Cardiac abnormality (particularly those causing left to right shunt) | May be evidence of biventricular failure (tachycardia, hepatomegaly and Pulmonary crackles). | Chest radiograph, ECG and echocardiogram |
Postinfectious obliterative bronchiolitis | Previous adenovirus35 (most common antecedent) infection, prolonged oxygen requirement, tachypnoea and crackles | Inspiratory and expiratory images on high-resolution c |
Wednesday 7 February 2018
PRESCHOOL WHEEZE
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