What diseases are children’s asthma easily confused with?
Cardiogenic asthma is common in left heart failure. The symptoms at the onset are similar to asthma, but cardiogenic asthma mostly has the history and signs of rheumatic heart disease and congenital heart disease. Paroxysmal cough, often coughing pink foam sputum, two lung can hear a wide range of vesicular sound and wheezing sound, the left heart boundary enlargement, heart rate increase, apex can hear galloping horse law.
During chest X-ray examination, cardiac enlargement and pulmonary congestion sign can be seen. Cardiac B-ultrasound and cardiac function examination are helpful to distinguish. If it is difficult to identify the selectivity of aerosol inhalation β 2 receptor agonists or injection of low-dose aminophylline for further examination after relieving symptoms. Do not use adrenaline or to avoid danger.
Have a history of contact with Mycobacterium tuberculosis and have symptoms of chronic Mycobacterium tuberculosis poisoning. Tuberculin test was positive in PPD test, but negative in bronchial provocation test or PEF variation rate was less than 15%; Acid fast bacilli were found in sputum smear, and sputum tuberculosis bacilli were positive by polymerase chain reaction (TB-PCR). Chest X-ray, chest CT and fiberoptic bronchoscopy can also be performed if necessary.
It is mostly caused by respiratory syncytial virus. It is mostly seen in infants under 3 years old, especially under 6 months old. There is no history of recurrent attacks. inhalation β The efficacy of 2 receptor agonists and systemic hormone use is uncertain.
Main signs: acute onset, first symptoms of upper respiratory tract infection, gradual wheezing, expiratory dyspnea, prolonged expiratory, expiratory wheezing and fine wet rales. Chest film: diffuse emphysema and patchy shadow.
Mycoplasma pneumoniae pneumonia
Manifestations: irritating dry cough, no obvious dyspnea, and the symptoms can last for 2 ~ 3 months. Main distinguishing points: no history of repeated cough and asthma, onset with respiratory tract infection symptoms such as nasal congestion, and then cough does not heal. The chest film has migratory patchy or cloud shadow, which can be effectively treated with macrolide antibiotics. Cold agglutination test ≥ 1 / 64 positive or Mycoplasma pneumoniae antibody positive.
Main manifestations: infiltrative changes in both lower lungs, decreased pulmonary diffusion function, negative bronchial provocation test or diastolic test, normal PEF variation rate, no increase of eosinophils and IgE, and no specificity in chest X-ray examination. Have a history of special environment or occupational exposure, and the corresponding allergen specific antibody in serum is positive.
Airway foreign body
There was no history of repeated cough and asthma in the past, and there was often a history of choking or definite foreign body inhalation during eating before the onset. Symptoms: asymmetric respiratory sound, weakened respiratory sound on the diseased side, weakened tactile tremor, local wheezing, etc.
Cough, expectoration, wheezing, shortness of breath and other symptoms are often persistent, with extensive wheezing and twisting sounds in both lungs. Negative bronchiectasis test or PEF variation rate < 15%, and the effect of antiasthmatic treatment is uncertain.
They often have a “hysterical” personality (strong and changeable emotions, self-centered, strong desire for expression, rich fantasy, exaggerated words and deeds, often with dramatic color), which is common among women. There were no abnormal signs in the lungs during the attack, no abnormalities in chest radiography, negative bronchial provocation test or PEF variation rate < 15%.
He has a history of severe pulmonary infection, repeated atelectasis and a large amount of pus and sputum.
Postnasal drip syndrome (PNDs)
Often have a history of rhinitis and sinusitis. There is retronasal drip and / or mucus adhesion and cobblestone like view on the posterior pharyngeal wall. Sinusitis: sinus film or CT showed that the thickness of sinus mucosa was more than 6mm, or the sinus cavity was blurred or flat, and the cough symptoms were relieved after treatment.
Eosinophilic bronchitis (EB)
Chest X-ray examination showed no special findings, pulmonary ventilation function was normal, bronchial provocation test was negative, and PEF variation rate was normal. Eosinophils in induced sputum are more than 3%. Oral or inhaled corticosteroids are effective and can help diagnose.
Gastroesophageal reflux (GOR)
The reflux of gastric contents into the esophagus stimulates the receptors at the lower end of the esophagus, resulting in paroxysmal or persistent cough. Identification points: there may be reflux symptoms, such as heartburn, upper abdominal fullness, etc. Bronchial provocation test was negative or PEF variation rate was less than 15%.