TABLE 2.

Signs/symptoms^* (red flags) suggesting an alternative diagnosis to asthma

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: Infection: croup, tracheitis Intrinsic: laryngomalacia, tracheal stenosis Extrinsic: vascular ring, tumour
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: Acute myocarditis/pericarditis Congenital heart disease

^*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