Evaluation of infants and children with refractory lower respiratory tract symptoms.

OBJECTIVE: To define the diagnostic possibilities for young children who present with recurrent wheeze.

DATA SOURCES: Review of medical literature and 30 years of practice experience.

STUDY SELECTION: Relevant medical literature.

RESULTS: When evaluating an infant or child presenting with recurrent respiratory symptoms, several diagnoses must be considered. The workup should include assessment of the risk factors for asthma and careful investigation into the specific symptoms. Recurrent or persistent wheezing and/or coughing often result in a diagnosis of asthma with therapeutic trials of asthma treatment. When the therapy is ineffective, other diagnoses should be considered, including gastroesophageal reflux, protracted bacterial bronchitis, tracheobronchomalacia, and cystic fibrosis. Appropriate testing should be performed in these pediatric patients.

CONCLUSION: In young children with recurrent lower airway symptoms who have a negative modified Asthma Predictive Index result, the described diagnostic possibilities should be considered.