Is It Asthma or Something Else?

Is It Asthma or Something Else

Since bronchial asthma in both children and adults is a clinical diagnosis (based on symptoms), it is very important to make a differential diagnosis: distinguish asthma from other diseases.


In the absence of obstruction, difficulty breathing and coughing can be caused by:

  • hyperventilation syndrome;
  • vocal cord dysfunction syndrome;
  • GERD (gastroesophageal reflux disease);
  • rhinitis (allergic, vasomotor and infectious);
  • heart disease, which can occur with shortness of breath;
  • pulmonary fibrosis.

If there is obstruction:

  • chronic obstructive pulmonary disease;
  • sarcoidosis;
  • bronchiectases;
  • foreign body;
  • stenosis of large airways;
  • obliterating bronchiolitis;
  • lungs’ cancer.


Recurrent respiratory viral infections. Remember the types of obstructions. In the absence of an allergic background, broncho-obstructive syndrome against the background of ARVI is not a basis for the diagnosis of asthma. ARVI symptoms: cough, difficulty in nasal breathing < 10 days; mild wheezing.

Acute bronchiolitis.

  • the disease occurs in children under 2 years;
  • patients born prematurely and with bronchopulmonary dysplasia have a severe course;
  • acute infection of the upper respiratory tract develops on day 2-5;
  • characterized by an increase in 3-4 days of coughing, shortness of breath, increased respiratory rate, wheezing;
  • there is no effect of bronchodilator therapy.

Gastroesophageal reflux (GERD).

  • disease of the gastrointestinal tract, in which there is a throwing of the contents of the stomach into the esophagus;
  • vomiting and heartburn can easily occur, especially after taking a large amount of food;
  • a cough increases in a prone position and disappears against the background of treatment of the gastrointestinal tract;
  • can manifest as recurrent bronchitis.

Foreign body in the respiratory tract (for example, in the bronchi).

  • rough strong cough and/or noisy breathing while eating or playing at the very beginning;
  • a prolonged cough, bronchitis, protracted pneumonia;
  • chryps are more often unilateral;
  • diagnosis is made after endoscopy.

Tracheophistinal fistula.

It is a developmental disorder in which the trachea (respiratory tract) and esophagus (gastrointestinal tract) communicate with each other.

  • disturbance of swallowing food;
  • recurrent bronchitis;
  • prolonged pneumonia and cough;
  • appearance or increase in the number of wheezing in the lungs after eating or drinking.

Congenital heart diseases.

  • heart murmur;
  • cyanosis of the skin, worse with eating;
  • a bad gain in weight.

Bronchopulmonary dysplasia.

  • congenital disease;
  • more often in premature infants;
  • very low birth weight;
  • the need for prolonged mechanical ventilation or oxygen therapy;
  • respiratory disorders are present from birth.


  • bronchiectases;
  • tuberculosis;
  • the vascular ring;
  • sarcoidosis;
  • tracheomalacia or bronchomalacia are defects in the development of respiratory organs;
  • cystic fibrosis is a hereditary disease;
  • primary ciliary dyskinesia is a hereditary disease;
  • primary immunodeficiency states;
  • vocal cord dysfunction.

It is also worth noting:

  • a psychogenic cough;
  • a loud cough, lack of communication with exposure to an allergen, respiratory infection, or physical exertion. This can be connected with negative psycho-emotional factors. There are no symptoms during sleep.

Complaints about difficulty breathing. The attack often begins with deep, frequent breaths, an improvement in respiratory arrest. The disease occurs against the background of psychoemotional arousal, excitement, hysterics, crying.


Bronchial asthma is a clinical diagnosis, which means it is made on the basis of symptoms.

The most important thing is to understand that the diagnosis of bronchial asthma implies that diseases from this list are excluded. This means that in addition to a pulmonologist and an allergist, it may be necessary to consult a cardiologist, a neurologist and even a psychotherapist.

Prolonged coughing can cause:

  • syndrome of dysfunction of the vocal cords (it is quite possible you need a competent ENT);
  • GERD (gastroesophageal reflux disease). If the child has a problem with the gastrointestinal tract, this is a direct indication for the GBDS;
  • rhinitis (allergic, vasomotor and infectious). A cough is due to the flow of mucus down the posterior pharyngeal wall, and irritation of the cough receptors;
  • saroidosis (but there would be changes on the x-ray);
  • bronchiectasis (coughing with large amounts of sputum, especially in the morning);
  • foreign body;
  • bronchiolitis (usually in young children);
  • hyperventilation syndrome (rarely in children).

Summary: you need a close contact with the pulmonologist, allergist, a consultation with a qualified ENT doctor. Undergo: EGF, spirometry with a bronchodilator test and have allergic tests.

Category: Asthma School

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4 responses to “Is It Asthma or Something Else?”

  1. 12Nathan says:

    At what age is a spirometry and fiberoptic gastroduodenoscopy allowed?

    • Asthma.School says:

      Spirometry can be done from the age of 5, fiberoptic gastroduodenoscopy can be done at an earlier age (after a consultation with a gastroenterologist).

  2. miahopkins says:

    Are skin allergy tests made 2 years ago are still relevant?

    • Asthma.School says:

      Yes, they are. It all depends on the symptoms. If the results of skin tests correspond to current symptoms, they are relevant.

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