title: Evaluation of infants and children with refractory lower respiratory tract symptoms.
abstract: OBJECTIVE
  To define the diagnostic possibilities for young children who present with recurrent wheeze.
  
  
  METHODS
  Review of medical literature and 30 years of practice experience.
  
  
  METHODS
  Relevant medical literature.
  
  
  RESULTS
  When evaluating an infant or child presenting with recurrent respiratory symptoms, several diagnoses must be considered. The workup should include assessment of the risk factors for asthma and careful investigation into the specific symptoms. Recurrent or persistent wheezing and/or coughing often result in a diagnosis of asthma with therapeutic trials of asthma treatment. When the therapy is ineffective, other diagnoses should be considered, including gastroesophageal reflux, protracted bacterial bronchitis, tracheobronchomalacia, and cystic fibrosis. Appropriate testing should be performed in these pediatric patients.
  
  
  CONCLUSIONS
  In young children with recurrent lower airway symptoms who have a negative modified Asthma Predictive Index result, the described diagnostic possibilities should be considered.
authors.affiliation: Capital Allergy and Respiratory Center, Sacramento, California 95819, USA. bchipps@capitalallergy.com
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Chipps
mesh_terms: D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D012135:Respiratory Sounds / Q000209:etiology; D012140:Respiratory Tract Diseases / Q000175:diagnosis*