pediatrics
Wheezing and Asthma in Infants and Young Children
Diagnosis
Chest x-ray for severe initial episode and sometimes for atypical or recurrent episodes For a first episode of severe wheezing, most clinicians do a chest x-ray to detect signs of an aspirated foreign body, pneumonia, or heart failure and pulse oximetry to assess the need for oxygen therapy. The presence of generalized hyperinflation on plain x-rays suggests diffuse air trapping as seen in asthma, whereas localized findings suggest structural abnormalities or foreign body aspiration. Chest x-ray may also indicate the presence of a vascular ring as the cause of wheezing (eg, right aortic arch). For children with recurrent episodes, exacerbations typically do not require testing unless there are signs of respiratory distress. Tests such as swallowing studies, contrast esophagram, CT, or bronchoscopy may be helpful for the few children with frequent or severe exacerbations or symptoms who do not respond to bronchodilators or other asthma drugs. 