Differentials
Pertussis
SIGNS / SYMPTOMS
Paroxysmal cough, inspiratory whooping, post-tussive vomiting, and, in infants, cyanosis or apnoea. Symptoms occur in three phases: catarrhal, paroxysmal, and convalescent.[43]
Croup
Bronchiolitis
SIGNS / SYMPTOMS
Primarily a disease of infancy (rare in children >1 year old); usually starts with upper respiratory tract symptoms (e.g., rhinitis and cough); fever, if present, usually low-grade. Cough then increases in severity, and lower respiratory tract symptoms develop (e.g., wheeze, retractions, tachypnoea).[48]
INVESTIGATIONS
Usually a clinical diagnosis.
Viral-induced wheeze
SIGNS / SYMPTOMS
Most commonly presents in children aged 1-5 years; there may be a history of intermittent wheezing associated with viral infection, with no symptoms between episodes; fever, if present, usually low-grade; symptoms respond to bronchodilator therapy (short-acting beta-agonist).[49]
INVESTIGATIONS
Usually a clinical diagnosis.
Foreign body aspiration (FBA)
SIGNS / SYMPTOMS
History of a choking episode with sudden onset of respiratory distress associated with coughing, gagging, or stridor. Unilateral decreased breath sounds and/or unilateral wheezing.[50]
INVESTIGATIONS
Chest x-ray: visualisation of radio-opaque foreign body or indirect signs if the foreign body is radiolucent (e.g., atelectasis, air trapping, pneumomediastinum).
Bronchoscopy is the standard of care for diagnosis and treatment of FBA.
Asthma exacerbation
SIGNS / SYMPTOMS
History of asthma and/or atopic disease (e.g., boggy mucous membranes); nocturnal cough, particularly if associated with wheeze; family history of asthma or atopy; may be triggered by physical exertion or airway irritants; fever and other signs of infection absent (unless exacerbation is virally triggered).[8]
INVESTIGATIONS
Bronchoconstriction responds to short-acting beta-2 agonist; no signs of infiltration on chest x-ray (normal or may show hyperinflation).[51]
Use of this content is subject to our disclaimer