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Clinical clues to alternative diagnoses in wheezy children

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Clinical clues to alternative diagnoses in wheezy children (features not commonly found in children with asthma)

Perinatal and family history

Possible diagnosis

Symptoms present from birth or perinatal lung problem

Cystic fibrosis; chronic lung disease of prematurity; ciliary dyskinesia; developmental 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 cough

Cystic fibrosis; bronchiectasis; protracted bronchitis; recurrent aspiration; host defence disorder; ciliary dyskinesia

Excessive vomiting

Gastro-oesophageal refl ux (+/- aspiration)


Swallowing problems (+/- aspiration)

Breathlessness with light-headedness and peripheral tingling

Hyperventilation/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


Focal or persistent radiological changes

Developmental anomaly; cystic fibrosis; post-infective disorder; recurrent aspiration; inhaled foreign body; bronchiectasis; tuberculosis



  • (1) BTS/SIGN (May 2008). British Guideline on the Management of Asthma.

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