Share this Article
Singapore Med J 2014; 55(5): 236-241; http://dx.doi.org/10.11622/smedj.2014064
Recurrent wheeze and cough in young children: is it asthma?
Ng CW, How CH
Correspondence: Dr Mark Ng Chung Wai, ng.chung.wai@singhealth.com.sg
ABSTRACT
A clinical diagnosis of asthma is often considered when a child presents with recurrent cough, wheeze and breathlessness. However, there are many other causes of wheeze in a young child. These range from recurrent viral infections to chronic suppurative lung disease, gastro-oesophageal reflux disease and rare structural abnormalities. Arriving at a diagnosis includes taking into consideration the symptomatology, triggers, atopic features, family history, absence of red flags and therapeutic trial, where indicated.
Keywords: asthma, childhood wheeze, diagnosis, primary care practitioner
Singapore Med J 2014; 55(5): 236-241; http://dx.doi.org/10.11622/smedj.2014064
REFERENCES
| 1. Hermann C, Westergaard T, Pedersen BV, et al. A comparison of risk factors for wheeze and recurrent cough in preschool children. Am J Epidemiol 2005; 162:345-50. http://dx.doi.org/10.1093/aje/kwi212 | ||||
| 2. Wright AL, Holberg CJ, Morgan WJ, et al. Recurrent cough in childhood and its relation to asthma. Am J Respir Crit Care Med 1996; 153(4 Pt 1):1259-65. http://dx.doi.org/10.1164/ajrccm.153.4.8616551 | ||||
| 3. Shields MD, Bush A, Everard ML, McKenzie S, Primhak R. BTS guidelines: Recommendations for the assessment and management of cough in children. Thorax 2008; 63 Suppl 3:iii1-iii15. PMid:17905822 | ||||
| 4. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest 2006; 129(1 Suppl):260S-283S. http://dx.doi.org/10.1378/chest.129.1_suppl.260S | ||||
| 5. Chang AB, Landau LI, Van Asperen PP, et al. Cough in children: definitions and clinical evaluation. Med J Aust 2006; 184:398-403. PMid:16618239 | ||||
| 6. Pescatore AM, Dogaru CM, Duembgen L, et al. A simple asthma prediction tool for preschool children with wheeze or cough. J Allergy Clin Immunol 2014: 133:111-8.e1-13. | ||||
| 7. Whitburn S, Costelloe C, Montgomery AA, et al. The frequency distribution of presenting symptoms in children aged six months to six years to primary care. Prim Health Care Res Dev 2011; 12:123-34. http://dx.doi.org/10.1017/S146342361000040X | ||||
| 8. Stevens CA, Turner D, Kuehni CE, Couriel JM, Silverman M. The economic impact of preschool asthma and wheeze. Eur Respir J 2003; 21:1000-6. http://dx.doi.org/10.1183/09031936.03.00057002 | ||||
| 9. Levy ML, Fletcher M, Price DB, et al. International Primary Care Respiratory Group (IPCRG) Guidelines: diagnosis of respiratory diseases in primary care. Prim Care Respir J 2006; 15:20-34. http://dx.doi.org/10.1016/j.pcrj.2005.10.004 | ||||
| 10. Weinberger M, Abu-Hasan M. Pseudo-asthma: when cough, wheezing, and dyspnea are not asthma. Pediatrics 2207; 120:855-64. http://dx.doi.org/10.1542/peds.2007-0078 | ||||
| 11. Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004; 59:469-78. http://dx.doi.org/10.1111/j.1398-9995.2004.00526.x | ||||
| 12. Doherty G, Bush A. Diagnosing respiratory problems in young children. Practitioner 2007; 251:20, 22-5. PMid:17882893 | ||||
| 13. Pedersen S. Preschool asthma – not so easy to diagnose. Prim Care Respir J 2007; 16:4-6. http://dx.doi.org/10.3132/pcrj.2007.00011 | ||||
| 14. Martinez FD, Wright AL, Taussig LM, et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995; 332:133-8. http://dx.doi.org/10.1056/NEJM199501193320301 | ||||
| 15. Wilson NM. Wheezy bronchitis revisited. Arch Dis Child 1989; 64: 1194-9. http://dx.doi.org/10.1136/adc.64.8.1194 | ||||
| 16. Bisgaard H. Use of inhaled corticosteroids in pediatric asthma. Pediatr Pulmonol Suppl 1997; 15:27-33. http://dx.doi.org/10.1002/(SICI)1099-0496(199709)15+<27::AID-PPUL7>3.0.CO;2-O | ||||
| 17. Taussig LM, Wright AL, Holberg CJ, et al. Tucson Children's Respiratory Study: 1980 to present. J Allergy Clin Immunol 2003; 111:661-75. http://dx.doi.org/10.1067/mai.2003.162 | ||||
| 18. Thomson F, Masters IB, Chang AB. Persistent cough in children and the overuse of medications. J Paediatr Child Health 2002; 38:578-81. http://dx.doi.org/10.1046/j.1440-1754.2002.00045.x | ||||
| 19. Molis WE, Bagniewski S, Weaver AL, Jacobson RM, Juhn YJ. Timeliness of diagnosis of asthma in children and its predictors. Allergy 2008; 63: 1529-35. http://dx.doi.org/10.1111/j.1398-9995.2008.01749.x | ||||
| 20. Beydon N, Davis SD, Lombardi E, et al. An Official American Thoracic Society/European Respiratory Society statement: pulmonary function testing in preschool children. Am J Respir Crit Care Med 2007; 175:1304-45. http://dx.doi.org/10.1164/rccm.200605-642ST | ||||
| 21. National Asthma Education and Prevention Program. Expert Panel Report III: Guidelines for the Diagnosis and Management of Asthma. Bethesda: National Heart, Lung, and Blood Institute, 2007 Aug. Report no.: 07-4051. | ||||
| 22. Brand PL, Baraldi E, Bisgaard H, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2008; 32:1096-110. http://dx.doi.org/10.1183/09031936.00002108 | ||||
| 23. Global strategy for the diagnosis and management of asthma in children 5 years and younger, Global Initiative for Asthma (GINA) 2009 [online]. Available at: www.ginasthma.org. Accessed April 2014. | ||||
| 24. Bacharier LB, Boner A, Carlsen KH, et al. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy 2008; 63:5-34. http://dx.doi.org/10.1111/j.1398-9995.2007.01586.x | ||||
| 25. Heymann PW, Platts-Mills TA, Johnston SL. Role of viral infections, atopy and antiviral immunity in the etiology of wheezing exacerbations among children and young adults. Pediatr Infect Dis J 2005; 24(11 Suppl):S217-22. http://dx.doi.org/10.1097/01.inf.0000188164.33856.f9 | ||||
| 26. Jackson DJ, Gangnon RE, Evans MD, et al. Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children. Am J Respir Crit Care Med 2008; 178:667-72. http://dx.doi.org/10.1164/rccm.200802-309OC | ||||
| 27. Lee KK, Hegele RG, Manfreda J, et al. Relationship of early childhood viral exposures to respiratory symptoms, onset of possible asthma and atopy in high risk children: the Canadian Asthma Primary Prevention Study. Pediatr Pulmonol 2007; 42:290-7. http://dx.doi.org/10.1002/ppul.20578 | ||||
| 28. Faniran AO, Peat JK, Woolcock AJ. Measuring persistent cough in children in epidemiological studies: development of a questionnaire and assessment of prevalence in two countries. Chest 1999; 115:434-9. http://dx.doi.org/10.1378/chest.115.2.434 | ||||
| 29. van Asperen PP. Cough and asthma. Paediatr Respir Rev 2006; 7:26-30. http://dx.doi.org/10.1016/j.prrv.2005.11.006 | ||||
| 30. Brodlie M, Graham C, McKean MC. Childhood cough. Clinical Review. BMJ 2012; 344:e1177. http://dx.doi.org/10.1136/bmj.e1177 | ||||
| 31. Ninan TK, Macdonald L, Russell G. Persistent nocturnal cough in childhood: a population based study. Arch Dis Child 1995; 73:403-7. http://dx.doi.org/10.1136/adc.73.5.403 | ||||
| 32. De Baets F, Bodart E, Dramaix-Wilmet M, et al. Exercise-induced respiratory symptoms are poor predicators of bronchoconstriction Pediatr Pulmonol 2005; 39:301-5. http://dx.doi.org/10.1002/ppul.20185 | ||||
| 33. de Benedictis FM, Selvaggio D, de Benedictis D. Cough, wheezing and asthma in children: lesson from the past. Pediatr Allergy Immunol 2004; 15:386-93. http://dx.doi.org/10.1111/j.1399-3038.2004.00179.x | ||||
| 34. Michel G, Silverman M, Strippoli MP, et al. Parental understanding of wheeze and its impact on asthma prevalence estimates. Eur Respir J 2006; 28:1124-30. http://dx.doi.org/10.1183/09031936.06.00008406 | ||||
| 35. Cane RS, Ranganathan SC, McKenzie SA. What do parents of wheezy children understand by "wheeze"? Arch Dis Child 2000; 82:327-32. http://dx.doi.org/10.1136/adc.82.4.327 | ||||
| 36. Elphick HE, Sherlock P, Foxall G, et al. Survey of respiratory sounds in infants. Arch Dis Child 2001; 84:35-9. http://dx.doi.org/10.1136/adc.84.1.35 | ||||
| 37. Elphick HE, Ritson S, Rodgers H, Everard ML. When a ''wheeze'' is not a wheeze: acoustic analysis of breath sounds in infants. Eur Respir J 2000; 16:593-7. http://dx.doi.org/10.1034/j.1399-3003.2000.16d04.x | ||||
| 38. Cane RS, McKenzie SA. Parents' interpretations of children's respiratory symptoms on video. Arch Dis Child 2001; 84:31-4. http://dx.doi.org/10.1136/adc.84.1.31 | ||||
| 39. Fernandes RM, Robalo B, Calado C, et al. The multiple meanings of "wheezing": a questionnaire survey in Portuguese for parents and health professionals. BMC Pediatrics 2011; 11:112. http://dx.doi.org/10.1186/1471-2431-11-112 | ||||
| 40. Metsälä J, Kilkkinen A, Kaila M, et al. Perinatal factors and the risk of asthma in childhood – a population-based register study in Finland. Am J Epidemiol. 2008; 168:170-8. http://dx.doi.org/10.1093/aje/kwn105 | ||||
| 41. London SJ, James Gauderman W, Avol E, Rappaport EB, Peters JM. Family history and the risk of early-onset persistent, early-onset transient, and lateonset asthma. Epidemiology 2001; 12:577-83. http://dx.doi.org/10.1097/00001648-200109000-00019 | ||||
| 42. Australian Centre for Asthma Monitoring 2009. Asthma in Australian children: findings from Growing Up in Australia, the Longitudinal Study of Australian Children. Cat. no. ACM 17. Canberra: AIHW [online]. Available at: http://www.aihw.gov.au/publication-detail/?id=6442468289. Accessed March 2014. | ||||
| 43. Sherriff A, Peters TJ, Henderson J, et al. Risk factor associations with wheezing patterns in children followed longitudinally from birth to 3½ years. Int J Epidemiol 2001; 30:1473-84. http://dx.doi.org/10.1093/ije/30.6.1473 | ||||
| 44. Kurukulaaratchy RJ, Matthews S, Holgate ST, Arshad SH. Predicting persistent disease among children who wheeze during early life. Eur Respir J 2003; 22:767-71. http://dx.doi.org/10.1183/09031936.03.00005903 | ||||
| 45. Castro-Rodríguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med 2000; 162(4 Pt 1):1403-6. http://dx.doi.org/10.1164/ajrccm.162.4.9912111 | ||||
| 46. Castro-Rodriguez JA. The Asthma Predictive Index: early diagnosis of asthma. Curr Opin Allergy Clin Immunol 2011; 11:157-61. http://dx.doi.org/10.1097/ACI.0b013e3283464c4a | ||||
| 47. Chang TS, Lemanske RF Jr, Guilbert TW, et al. Evaluation of the Modified Asthma Predictive Index in High-Risk Preschool Children. J Allergy Clin Immunol Pract 2013; 1:152-6. http://dx.doi.org/10.1016/j.jaip.2012.10.008 | ||||
| 48. Guilbert TW, Morgan WJ, Krawiec M, et al. The Prevention of Early Asthma in Kids study: design, rationale and methods for the Childhood Asthma Research and Education network. Control Clin Trials 2004; 25:286-310. http://dx.doi.org/10.1016/j.cct.2004.03.002 | ||||
| 49. Pattemore PK. Infant wheeze: is asthma a possibility? J Paediatr Child Health 2013; 49:991-4. http://dx.doi.org/10.1111/jpc.12395 | ||||
| 50. Martinati LC, Boner AL. Clinical diagnosis of wheezing in early childhood. Allergy 1995; 50:701-10. http://dx.doi.org/10.1111/j.1398-9995.1995.tb01210.x | ||||
| 51. de Jongste JC, Shields MD. Cough. 2: Chronic cough in children. Thorax 2003; 58:998-1003. http://dx.doi.org/10.1136/thorax.58.11.998 | ||||
| 52. Donnelly D, Critchlow A, Everard ML. Outcomes in children treated for persistent bacterial bronchitis. Thorax 2007; 62:80-4. http://dx.doi.org/10.1136/thx.2006.058933 | ||||
| 53. Saglani S, Nicholson AG, Scallan M, et al. Investigation of young children with severe recurrent wheeze: any clinical benefit? Eur Respir J 2006; 27:29-35. http://dx.doi.org/10.1183/09031936.06.00030605 | ||||
| 54. Illi S, von Mutius E, Lau S, et al. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. J Allergy Clin Immunol 2004; 113:925-31. http://dx.doi.org/10.1016/j.jaci.2004.01.778 | ||||
| 55. Sly PD, Boner AL, Björksten B, et al. Early identification of atopy in the prediction of persistent asthma in children. Lancet 2008; 372:1100-6. http://dx.doi.org/10.1016/S0140-6736(08)61451-8 | ||||