Asthma pathway (BTS, NICE, SIGN) [SIGN 244]
- 78. Marchant JM, Masters IB, Taylor SM, Chang AB. Utility of signs and symptoms of chronic cough in predicting specific cause in children. Thorax 2006;61(8):694-8.
Alternative diagnoses in wheezy children
This content is from the BTS/SIGN British guideline on the management of asthma (SIGN 158), 2019.
| Clinical clue | Possible diagnosis |
| Symptoms present from birth or perinatal lung problem | Cystic fibrosis; chronic lung disease of prematurity; ciliary dyskinesia; developmental lung anomaly |
| Family history of unusual chest disease | Cystic fibrosis; neuromuscular disorder |
| Severe upper respiratory tract disease | Defect of host defence; ciliary dyskinesia |
| Symptoms and signs | |
| Persistent moist cough78 | Cystic fibrosis; bronchiectasis; protracted bacterial bronchitis; recurrent aspiration; host defence disorder; ciliary dyskinesia |
| Excessive vomiting | Gastro-oesophageal reflux (with or without aspiration) |
| Paroxysmal coughing bouts leading to vomiting | Pertussis |
| Dysphagia | Swallowing problems (with or without aspiration) |
| Breathlessness with light-headedness and peripheral tingling | Dysfunctional breathing, panic attacks |
| Inspiratory stridor | Tracheal or laryngeal disorder |
| Abnormal voice or cry | Laryngeal problem |
| Focal signs in chest | Developmental anomaly; post-infective syndrome; bronchiectasis; tuberculosis |
| Finger clubbing | Cystic fibrosis; bronchiectasis |
| Failure to thrive | Cystic fibrosis; host defence disorder; gastro-oesophageal reflux |
| Investigations | |
| Focal or persistent radiological changes | Developmental lung anomaly; cystic fibrosis; postinfective disorder; recurrent aspiration; inhaled foreign body; bronchiectasis; tuberculosis |
