Asthma Mimics: Conditions which look like Asthma but are NOT!

Asthma is a condition seen world over in adults and children. It is estimated that approximately 20-25 % of the population suffers from asthma. In some patients asthma symptoms could be occasional while in some they can be present throughout the year.

Common symptoms of asthma are cough, wheezing (a whistling sound from the chest while breathing out), chest tightness and breathlessness. Children often get asthma attacks when the symptoms increase rapidly and can lead to difficulty in breathing, need for emergency visits and occasionally hospital admission.

Since such symptoms are common with many other respiratory conditions in children they can be mistaken for asthma. This leads to a delay in diagnosis, inappropriate treatment and poor improvement in a child's symptoms. In this article we shall discuss various conditions which can mimic asthma in young children.

What are the common conditions which can mimic asthma in children?

Many conditions can behave likeasthmabut may not be. Some children have weak airway walls since birth called tracheomalacia (weakness of the windpipe or trachea) or bronchomalacia (weakness of the bronchi). Compression to the windpipe from outside due to a blood vessel can lead to obstruction to the windpipe and hence get wheezing. Certain genetic conditions like cystic fibrosis and primary ciliary dyskinesia leads to excess mucus production in the airways and recurrent chest infections.

Gastro-esophageal refluxor acid from the stomach coming into the food pipe can also lead torespiratory problemsand wheezing. Young children can sometimes aspirate a foreign particle into the airways like small pieces of plastic, toy, nuts etc. Certain infections liketuberculosis, tropical pulmonary eosinophilia and allergic bronchopulmonary aspergillosis can also lead to similar symptoms. Immune-deficiency disorders can also present in similar ways with recurrent respiratory problems. Children with heart problems can also present with repeated chest infections and wheezing.

What are the symptoms and signs which points against asthma?

Symptoms and signs which suggest alternative diagnosis are wet cough, cough with phlegm, cough since birth, recurrent pneumonias, recurrent wheezing in the first 6 months of age, need for frequent admissions, and poor weight gain. Poor response to asthma medicines is also a very important indicator that the child may not have asthma and have an alternative diagnosis.

What are the investigations which might be needed in such situations?

Children who have symptoms suggestive of asthma should undergo a lung function test either a spirometry or impulse oscillometry for confirmation of diagnosis. Children suspected to have an asthma mimic would require specific investigations to confirm the disease leading to the problem. Investigations which might be required in such cases could be CT Chest, flexible bronchoscopy, sweat chloride, tests for immunodeficiency disorders, etc. These are specialized investigations which are done on a case-to-case basis which is decided after reviewing the child in detail.

In case your child is having asthma-like symptoms but having any clinical pointers of an asthma mimic or the response to treatment is not optimal you might be dealing with an asthma mimic. You need to get in touch with a pediatric pulmonologistfor proper evaluation, investigations and treatment.