Determining the cause of recurrent wheezing in infants

Although the most common cause of wheezing in infants is asthma, other causes should be considered. The differential diagnosis includes foreign-body aspiration, vascular rings, laryngotracheobronchomalacia, bronchiolitis, cystic fibrosis, bronchopulmonary dysplasia, and gastroesophageal reflux. A sudden onset of wheezing, choking, or coughing suggests foreign-body aspiration, while persistent stridor that was present at birth may indicate laryngeal webs. The presence of cough, fever, and rhinitis is consistent with bronchiolitis. Selected tests, such as chest radiography, bronchoscopy, barium esophagography, laryngoscopy, airway fluoroscopy, endoscopy, CT, and biopsy, can help confirm the diagnosis.