All that wheezes is not asthma

“All that wheezes is not asthma” is a famous quote made by Dr Chevalier Jackson an ENT surgeon in the Boston Medical Quarterly in 1865. This quote is also so true in today’s world and reminds us that there are many causes of wheezing and difficulty in breathing besides asthma.

What can cause wheezing besides asthma?
Since Asthma is the commonest cause of wheezing in children all wheezing is considered to be asthma. On the contrary there can be many other causes of wheezing besides asthma. Other important causes are foreign body in the child’s airway, gastroesophageal reflux, tracheomalacia (collapse of airway when breathing), blood vessels compressing on the windpipes, bronchiectasis (a chronic lung condition with abnormal widening of small airways), cystic fibrosis and allergic broncho-pulmonary aspergillosis (ABPA).

Everything That Wheezes Is Not Asthma

What are the clues which suggest that this wheezing is not Asthma?
There are many clues which can suggest that the cause of wheezing is not asthma. These clinical clues should always be looked for and if present these children should be investigated for other causes of wheezing. Children who start to wheeze very early in life (less than 6 months of age) and have repeated severe episodes requiring hospital admissions have a high chance of having problems. Children having repeated pneumonias in the chest, not gaining adequate weight and height are also likely to have alternate diagnosis. Children with bronchiectasis or cystic fibrosis have a wet cough or cough with phlegm which is uncommon in asthma. Children having persistent noise from the airway of the child also warrants further investigations. In the last any child with wheezing but a poor response to asthma treatment should be evaluated for other causes of wheezing.

What investigations might be required for diagnosis of causes of wheezing in children?
Children with wheezing suspected to have alternate diagnosis requires additional investigations for proper diagnosis for the cause of wheezing. The investigations required depend on the individual child and hence be tailored according to the case. The investigations might include a lung function test in the form of a spirometry or impulse oscillometry, flexible bronchoscopy, CT scan chest, sweat chloride level and reflux scan.

In case your child is having persistent wheezing with any red flag signs or poor response to treatment you need to consult a pediatric pulmonologist for clinical evaluation, investigations and treatment.

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All that wheezes is not Asthma!!

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