Reactive airway disease/asthma exacerbation vs viral illness?

Discussion in 'Pediatrics' started by Hemichordate, Apr 15, 2017.

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  1. Hemichordate

    Hemichordate Peds 7+ Year Member

    May 5, 2008
    What's the best way (in a patient with wheezing), to determine if this is likely due to reactive airway disease or asthma exacerbation, vs a viral illness?
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  3. mvenus929

    mvenus929 10+ Year Member

    Jul 6, 2006
    Have a fancy lab with a respiratory viral panel and see if something comes up positive.

    Or look for other symptoms (nasal congestion, rhinorrhea, fevers, conjunctivitis, sick contacts, etc), recognizing that some overlap with seasonal allergies, so you'll need to know if they have those and if they were exposed to any of their allergens.
  4. saqrfaraj

    saqrfaraj 7+ Year Member

    May 16, 2007
    These two things aren't mutually exclusive. Viral respiratory infections are a very common trigger for asthma exacerbations. You can also have viral-induced wheezing associated with LRTIs caused by crud in the smaller airways (i.e bronchiolitis), but this doesn't mean the patient necessarily has asthma.

    In the midst of an acute illness, your best bet is probably the history: Previous diagnosis of asthma? History of wheezing outside of illnesses (exercise, etc.)? Bronchodilator responsiveness? Family history of atopy that would suggest an increased risk for asthma?

    Remember that the diagnosis of asthma requires multiple episodes of reversible bronchoconstriction and airway inflammation (it's recurrent), so you can't make a definitive diagnosis if this is the patient's first episode of wheezing. When the patient is well again and if they are old enough to cooperate, you can consider pulmonary function testing to look for reversible airway obstruction.
  5. sliceofbread136

    sliceofbread136 5+ Year Member

    Nov 5, 2011
    Aren't rvps like $1500? Wouldn't it be better to just trial a bronchodilator?
  6. Stitch

    Stitch Jedi Ninja Wizard SDN Moderator 10+ Year Member

    Dec 12, 2002
    There isn't a great way to do it, and as mentioned above the two can come together. History of wheezing is important, but I generally say treat the physiology you are seeing/hearing instead of anchoring to and treating a certain diagnosis. If you hear wheezing try some albuterol and see what happens, especially if they have a history of wheezing. Know that if the kid is febrile and showing other signs of infection, it's more likely to be viral. You won't always be able to tell, and that's ok.
  7. wellchild

    wellchild For your health 5+ Year Member

    Nov 7, 2010
  8. mvenus929

    mvenus929 10+ Year Member

    Jul 6, 2006
    We keep being told different things about the cost, and there's words going around that it's required for bed placement, which is very frustrating.

    But, as mentioned above, you can have both. And some bronchiolitis does respond to albuterol, though it's not very often. So that can only really be a rough gauge. So, you can prove they do or do not have a viral illness with an RVP, but can't necessarily diagnose them with asthma based on responsiveness to albuterol.
  9. SurfingDoctor

    SurfingDoctor "Hooray, I'm useful" 10+ Year Member

    I think people are getting cost and charge mixed together. Cost is the money the hospital uses to run a test, provide a room, etc. Charge is the money the hospital bills for the service. For instance, hospitals charge $100+ for a dose of Tylenol, but the cost is much less.

    As for the RVP question, in a kid who is febrile and wheezing, I personally think it is reasonable. 1) if gives the provider and family a specific answer if positive 2) is more accurate than rapid serology based testing 3) tests for more viruses 4) prevents exploring additional avenues when positive. Also take it in the context of a hospitalization for bronchiolitis. Just the bed space alone is going to be an approximate $4000 to $5000 per day. This doesn't include provider service fees, medications, other diagnostic tests, etc. So a 4 day hospital stay is going to be about a $25000+ charge. However the actual cost, is lower.
  10. Maybe I'm using the term wrong, but when I say RAD I guess I mean what I've heard called "transient wheeze of childhood/infancy"--what the adult medicine doctors in that article refer to as "not enough data in a young child" or someone who wheezes with viral illness as a toddler/until 3 y/o and then grows out of it

    Edited because I got the age range wrong for transient wheeze
    Last edited: Apr 18, 2017
    sliceofbread136 likes this.
  11. flynnt

    flynnt Member 10+ Year Member

    Sep 24, 2001
    I think the multiplex viral panels are useful only if they are going to change management*(cohort with other children with same disease process, forgo abx, forgo other testing to search for etiology of illness). They so sound very cool because we can say definitively "it's X" rather then "umm, probably a virus?". Ordered thoughtfully, they can be helpful.

    However, I fear they will become an extension (a potentially much more expensive extension) of the RSV RADT. A test that tells you about exactly one virus and absolutely nothing about the child's hydration and respiratory status.

    *Exceptions would include research and certain public health purposes.
    WheezyBaby likes this.
  12. thetubes

    thetubes 7+ Year Member

    Jan 26, 2008
  13. I think it's partly where the "only 30% of teeny kids who wheeze get asthma" comes from

    (Of the 16,333 children studied, 1,221 (7.5%) were classified as having had transient early wheezing, 671 (4.1%) as having had persistent wheezing, and 918 (5.6%) as having had late-onset wheezing, while 13,523 (82.8%) formed the control group.)

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