🫁 Chapter 422 · Recurrent or Persistent Wheeze

Chronic or Recurrent Respiratory Symptoms | Nelson Textbook of Pediatrics 22nd Edition | Wheezing phenotypes (transient early, persistent, late-onset), differential diagnosis: asthma, cystic fibrosis, PCD, bronchiolitis, foreign body, VCD, tracheomalacia. Diagnostic workup: PFT, bronchodilator response, methacholine, chest CT, sweat test, bronchoscopy.

🌐 paeds.online — Pakistan's Pediatric Platform

📋 30 Clinical Scenarios — Recurrent & Persistent Wheeze (FCPS/Nelson)

📇 High‑Yield Cards: Wheeze Differential & Diagnosis (Chap 422)

🩺 Interactive Wheeze Phenotype & Etiology Guide

Select a wheeze pattern or condition for diagnostic clues and recommended workup.

📋 Stepwise Approach to Recurrent Wheeze (Nelson Ch 422)

    ConditionKey FeaturesDiagnostic Test
    AthmaAtopy, episodic, reversible obstructionSpirometry + bronchodilator, FeNO, methacholine
    CF (Cystic fibrosis)Wet cough, FTT, steatorrhea, clubbingSweat chloride, CFTR genetics
    PCDNeonatal distress, situs inversus, sinusitisNasal NO (<77), ciliary EM
    Foreign bodySudden onset, asymmetric breath soundsExpiratory CXR, rigid bronchoscopy
    Tracheomalacia / BronchomalaciaMonophonic wheeze, barking cough, worse with feeding/cryingFlexible bronchoscopy
    VCD (Vocal cord dysfunction)Inspiratory stridor/wheeze, normal PFT between attacksLaryngoscopy during symptoms, flow-volume loop

    ⚡ Reflex Prompts — When to Suspect Non‑Asthma Causes of Wheeze

    📖 Summary: Recurrent or Persistent Wheeze — Nelson 22nd Ed