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All That Wheezes Isn’t Asthma: Learn to Identify Other Causes :

September 15, 2017

Editor's note: The 2017 AAP National Conference & Exhibition will take place from Sept. 16-19 in Chicago.

Not all wheezing is asthma.

That’s the message Erik Hysinger, MD, MS, will convey during the session titled “It's Not Asthma: Diagnosis and Management of Localized Wheezing (F4042)” from 9:30-10:15 am Tuesday in McCormick Place West, W183 A.

Dr. Hysinger said his primary goal is to help the general pediatrician identify causes of local wheezing.

“We often get pigeon-holed into thinking about asthma, but refractory focal wheezing is not a consistent diagnosis with asthma and often is associated with some pathology that can be pretty dangerous and needs pretty aggressive evaluation,” said Dr. Hysinger, assistant professor of pulmonary medicine at Cincinnati Children’s Hospital Medical Center.

Among the causes of localized wheezing are foreign bodies, bronchomalacia, airway tumors, mucus plugs and airway compression due to masses or significant scoliosis.

Dr. Hysinger will present case reports of two of his patients with focal wheezing and will show bronchoscopic images or videos, chest X-rays and chest computed tomography scans of the patients. Both had been diagnosed with and treated aggressively for asthma before being referred to Dr. Hysinger.

When a patient presents with wheezing, Dr. Hysinger suggests pediatricians do the following: “The first thing to do is just look at the child, listen to the child and see if you can characterize the type of wheezing. … Where is it coming from? Is it focal or diffuse? What is the quality of wheezing? Is it homophonous or polyphonic?

“Asthma should be a diffuse process,” he said. “If you have focal wheezing, that’s not something that’s consistent with asthma.”

Also inconsistent with asthma is wheezing that can be heard from across the room, which indicates an airway pathology.

While focal wheezing generally should be referred, Dr. Hysinger will outline the workup steps a general pediatrician could do before the child sees a specialist.

He also offers this advice: “Don’t trust focal wheezing.”

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