Table 1.

Clinical clues to alternative diagnosis in children with wheezing.

Clinical clue	Possible diagnosis
PERINATAL AND FAMILY HISTORY
Symptoms present from birth	Chronic lung disease of prematurity, PCD, CF
Family history of unusual chest disease	CF, Neuromuscular disorders, PCD
Severe upper respiratory tract disease	PCD
SYMPTOMS AND SIGNS
Persistent moist cough	PBB, Bronchiectasis, Recurrent aspiration, PCD, CF
Excessive vomiting	GERD (w/without aspiration)
Dysphagia	Swallowing problems (w/without aspiration)
Breathlessness with light headedness and peripheral tingling	Dysfunctional breathing, Panic attacks
Inspiratory stridor	Tracheal or laryngeal disorder
Abnormal voice or cry	Laryngeal problems
Focal signs in chest	Developmental anomaly, FB, Post-infective syndrome
Persistent wheeze	Extrinsic intra thoracic airway compression, Airway-malacia, Luminal obstruction, CF, FB
Finger clubbing	CF, Bronchiectasis
Failure to thrive	CF, GERD

CF, cystic fibrosis; FB, foreign body; GERD, gastro-esophageal reflux disease; PBB, protracted bacterial bronchitis; PCD, primary ciliary dyskinesia.