Table 1.

Differential diagnoses and diagnostic clues to consider when assessing a child with problematic severe asthma

Differential diagnosis

Bronchiectasis

Obliterative bronchiolitis

Dysfunctional breathing

Foreign body

External airway compression, eg, vascular ring

Gastroesophageal reflux

Aspiration

Pertussis

Cystic fibrosis

Primary ciliary dyskinesia

Tracheobronchomalacia

Heart failure

Hypersensitivity pneumonitis

Diagnostic clues

Poor treatment response

Absence of any objective measures

Productive cough

Polyps

Failure to thrive

Nasal discharge from birth

Clubbing