Persistent or recurrent wheezing is a common cause for referral to pediatric pulmonology. These patients require a detailed work-up to elicit the etiology of wheezing as they often represent a diagnostic dilemma. Objective: To examine the components of the diagnostic course typically taken in these infants and the primary diagnoses given. To compare the epidemiology of patients referred for wheezing with the two most common diagnoses, gastroesophageal reflux (GER) and asthma.
A retrospective review was performed on 56 infants, mean age 10 months; range 2- 31 months, referred for recurrent or persistent wheezing. All of these patients had infant pulmonary function tests. The majority of patients had chest x-rays, pH probe studies, and upper GI series. A few others had modified barium swallow studies, allergy testing, and sweat chloride tests depending on the clinical presentation.
The most common diagnoses were GER and asthma. Asthma, both as a primary diagnosis or with secondary diagnoses, was found in 40/56 or 71% of patients. GER, alone or with other diagnoses, was found in 27/56 or 48% of patients. There was no difference between these two groups regarding a parental history of asthma, prematurity, or NICU stay. There was no difference in family size. There was no difference in reported cases of bronchiolitis or pneumonia between the two groups. Environmental smoke exposure was slightly more common in the GER group. More patients with asthma had pets versus those with GER. A history of breastfeeding was less common in the asthma group. More patients with asthma had attended daycare versus those with GER. A clinical history of reflux was much more common in the GER group.
Although wheezy infants constitute a heterogeneous group of patients, the most common diagnosis in this cohort is asthma and gastroesophageal reflux.
The aspects of epidemiology most helpful in distinguishing the asthma patients versus the GER patients included clinical history of reflux, history of breastfeeding, history of daycare attendance, and history of eczema.
Nemr Eid, None.