Asthma Management Handbook
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Table. Findings that require investigations in children



Persistent cough that is not associated with wheeze/breathlessness or systemic disease

 Unlikely to be due to asthma

Onset of signs from birth or very early in life

Suggests cystic fibrosis, chronic lung disease of prematurity, primary ciliary dyskinesia, bronchopulmonary dysplasia, congenital abnormality

Family history of unusual chest disease

Should be enquired about before attributing all the signs and symptoms to asthma

Severe upper respiratory tract disease (e.g. severe rhinitis, enlarged tonsils and adenoids or nasal polyps)

Specialist assessment should be considered

Crepitations on chest auscultation that do not clear on coughing

Suggest a serious lower respiratory tract condition such as pneumonia, atelectasis, bronchiectasis

Unilateral wheeze

Suggests inhaled foreign body

Systemic symptoms (e.g. fever, weight loss, failure to thrive)

Suggest an alternative systemic disorder

Feeding difficulties, including choking or vomiting

Suggests aspiration – specialist assessment should be considered

Inspiratory upper airway noises (e.g. stridor, snoring)

Acute stridor suggests tracheobronchitis (croup)

Persistent voice abnormality

Suggests upper airway disorder

Finger clubbing

Suggests cystic fibrosis, bronchiectasis

Chronic (>4 weeks) wet or productive cough

Suggests cystic fibrosis, bronchiectasis, chronic bronchitis, recurrent aspiration, immune abnormality, ciliary dyskinesia

Focal (localised) lung signs

Suggests pneumonia

Nasal polyps in child under 5 years old

Suggests cystic fibrosis

Severe chest deformity

Harrison’s Sulcus and Pectus Carinatum can be due to uncontrolled asthma, but severe deformity suggests an alternative diagnosis

Obvious breathing difficulty, especially at rest or at night

Specialist assessment should be considered

Recurrent pneumonia

Specialist assessment should be considered

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