TABLE 2.
Signs and/or symptoms | Alternative diagnoses |
---|---|
Persistent nasal discharge | Infectious/allergic rhinosinusitis† |
Stridor; noisy breathing worse when crying, eating, supine or with respiratory infection | Upper airway narrowing:
|
Acute onset of cough, wheeze or stridor during eating or playing; history of choking, recurrent pneumonia in same location | Foreign-body inhalation |
Aspiration of food/gastric contents | |
First episode wheeze in child <1 year | Bronchiolitis† |
Sick contacts, focal signs on chest radiograph | Pneumonia†, atelectasis†, tuberculosis, pertussis |
Severe, paroxysms of cough, possibly initially associated with a ‘whoop’, | Pertussis |
Premature birth, needed prolonged supplemental oxygen ± mechanical ventilation | Bronchopulmonary dysplasia |
Symptoms since infancy, recurrent pneumonia, focal signs on chest radiograph | Congenital pulmonary airway malformation |
Chronic wet cough, clubbing, failure to thrive, recurrent pneumonia, onset in infancy, ± steatorrhea | Bronchiectasis, cystic fibrosis |
Neonatal respiratory distress, early onset year-round daily cough and nasal congestion ± situs inversus | Primary ciliary dyskinesia |
Cough when supine, when feeding; vomiting after feeding, abdominal discomfort | Gastroesophageal reflux disease† |
Dysphagia, cough triggered by eating/drinking | Eosinophilic esophagitis |
Feeding intolerance, wet cough or noisy breathing after eating | Swallowing problem ± aspiration |
Recurrent, persistent, severe or unusual infections | Immune dysfunction |
Cardiac murmur, cardiac failure, cyanosis when eating, failure to thrive, tachypnea, hepatomegaly | Pulmonary edema due to:
|
Nonexhaustive list of signs and symptoms suggestive of possible alternative diagnoses, prompting additional investigations and/or a different management in the preschool child. Symptoms and signs listed may overlap among different diseases;
Indicates the most frequent alternative diagnoses to, or comorbidities associated with, asthma