Conditions That Are Often Mistaken for Asthma on Children
Posted on 09. Feb, 2011 by Allyson Drewry in Health
When a pediatrician tries to make a diagnosis, he will study the detailed history of present symptoms. Consequently, parents need to provide detailed and specific information. In certain situation the pediatrician will need to rule out conditions that can be mistaken for asthma symptoms to arrive at an accurate final diagnosis. Many different surgical and medical conditions can trigger symptoms similar to asthma and this fact should be considered when the child is undergoing a diagnosis. Although some symptoms may mimic asthma, they are not necessarily related to lung problems.
Once the physical and history examinations have been performed, the pediatrician may order a few more tests to improve the evaluation results. These tests may include rhinoscopy of the vocal cord, throat and nose; CAT scans of the sinuses, X-ray examination of the upper airways and chest; lung function tests and allergy tests. Luckily, most children with asthma never require such a complete and extensive workup.
Some children may already wheeze before their first birthday. When it happens, respiratory tract infection can be the actual cause of wheezing. The condition is called bronchiolitis, a viral infection that causes swelling, inflammation and finally bronchioles narrowing. This sequence of events can trigger respiratory distress and wheezing.
Tracheomalacia is also a condition found in a few newborns and is likely caused by incomplete cartilaginous rings development. Infants with this condition often develop inspiratory stridor, a noise heard when the child inhales. Stridors may sound like a wheeze, but wheezing on children with the real asthma happens when the child exhales (breathes out). Luckily, the cartilage rings will become stronger after 2 or 3 years and the stridors may eventually disappear.
A few months after labor, some congenital anomalies, for example, bronchopulmonary dysplasia, tracheostenosis, laryngeal webs and vascular rings can also induce wheezing and breathing difficulty. However, these physical abnormalities can be detected with appropriate hi-res CAT scans, MRI and X-ray. In these cases, wheezing is only heard unilaterally (one side of the child’s chest) and bronchodilator won’t provide effective symptom relief. Both indications are enough for a doctor to suspect that the child doesn’t have asthma and a chest X-ray can confirm the diagnosis.
Adenoids or enlarged tonsils can produce noises that are similar to a wheeze and cause nighttime coughs. A diagnosis should be based on the physical examination and initial history.
GERD (Gastroesophageal reflux disease) symptoms include coughing after bedtime and vomits after eating. A child who complains of discomfort and heartburn after meal can have GERD. This condition often coexists with asthma; heartburn can serve as a trigger for asthma or in many cases aggravate it. GERD patients should receive continuous treatment from either a gastroenterologist or otolaryngologist. When acid reaches the uppermost respiratory passages, wheezing and coughing can occur, which is similar to asthma. Luckily, GERD can be treated relatively easily, for example by making changes on the child’s lifestyle and dietary habit, also drugs that can reduce acid production. Sometimes, simply by not allowing your child eat three hours before bedtime and removing carbonated drinks, GERD symptoms will be reduced significantly.
If the child also has chronic obstructive lung disease, then cystic fibrosis is possible. Respiratory symptoms that accompany cystic fibrosis are usually recurrent pulmonary infections, wheezing and chronic coughs. Cystic fibrosis is considered as a rare health condition and happens genetically in 0.03% newborns and currently affects about 30,000 persons in the U.S. alone. Often, children with cystic fibrosis also have bronchial asthma. Diagnosis of cystic fibrosis can be confirmed with sweat chloride and DNA-based tests. Sinusitis and rhinitis may cause severe coughing, which often worsens after bedtime. Pains on cheekbones and forehead; postnasal drip and nasal congestion may suggest problems in the sinuses and nose. If the suspected area is around the sinuses, the doctor may order a CAT scan to get a visualization of the area and confirm the diagnosis. The treatments may include intranasal steroid sprays, saline sinus irrigation, decongestants, antihistamines and antibiotics therapy.
VCD (vocal cord dysfunction) was first described in early 1980’s. It occurs due to paradoxical and abnormal motions of the vocal cord. During normal breathing, vocal cords will move apart and open, however on children with VCD, vocal cords move together. On a normal child, vocal cords have a shape that is similar to a “V” and when the child inhales, the vocal cords will have a “U” shape. The abnormal movement cause specific symptoms, including hoarseness, persistent wheezing, trouble inhaling, shortness of breath and tightness on the throat and chest. VCD doesn’t include nocturnal symptomatology characteristic of asthma and it also has a preponderance of throat-related symptoms. VCD can also happen to adolescent and adults, especially those between 20 and 40 years old. In younger people, VCD is often triggered by intense competitive sports and may be associated with a high achieving and driven personality style. In adults, VCD may also happen due to psychological factors and other less understood reasons.
The first suspicion of VCD often arises when the child fail to respond well to common asthma medications. Children with VCD may visit the ER frequently due to severe respiratory symptoms. This condition is often confirmed in diagnosis using fiber-optic examination when an attack occurs. The doctor may also try to determine if VCD is also accompanies by asthma, because both condition can still coexist. When treating VCD, the doctor will discontinue non-indicated medication, especially corticosteroids. A speech pathologist may provide treatment that can control the condition. If the doctor suspects a child has VCD, he may refer you to a health center familiar with this condition. The child may also need psychological support and relaxation exercises.
