Pediatric Reactive Airway Disease Clinical Presentation

Updated: Jul 16, 2021
  • Author: Eric S Chin, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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The following information should be elicited:

  • Initiation of symptoms (More than a few days decreases the chance of quick reversal in the ED because of prolonged inflammation and mucous plug formation)

  • Upper respiratory tract infection (URI) symptoms, fever, and production of phlegm

  • Precipitating factors

  • Use of an bronchodilator inhaler; how often it was used in the past 24-48 hours prior to the ED visit; how often it was used over the past week or month

  • How many inhalers were used in the past month

  • How many puffs are being administered with each use and if the inhaler is being used with a spacer

  • Compliance with use of corticosteroid inhaler (Ask if it was used daily despite any symptoms of wheezing)

  • Date of last ED visit; how severe the current episode is compared with previous episodes [13]

  • Date of the last hospital admission

  • Number of admissions in the past year; number of intensive care unit admissions

  • History of intubation and how long ago it was

  • Recent use of oral steroids

  • Factors that usually initiate symptoms

  • Whether this is a typical episode

  • Presence of any underlying cardiac, GI, or immunologic diseases

  • Other current medications

  • Exposure to tobacco smoke and allergens (ie, cat dander)

  • Ability to tolerate fluids

  • Recent mental status changes

  • Baseline peak expiratory flow rate (PEFR)

  • History of atopic dermatitis or other allergic skin conditions [14]

  • Dry cough or wheezing that is often worse at night

  • History of recurrent wheezing and dyspnea

  • Wheeze or cough after active playing

  • Relationship to emotional expressions

  • Relationship to menses


Physical Examination

Physical examination findings that may be seen in patients with reactive airway disease include the following:

  • Fever

  • Tachycardia

  • Diaphoresis

  • Poor feeding

  • Flushing, cyanosis

  • Subcutaneous emphysema

  • Intercostal retractions

  • Increased anteroposterior diameter or pectus carinatum

  • Tachypnea, dyspnea

  • Wheezing

  • Coughing

  • Distant breath sounds, hyperresonance, poor air movement to result in wheezing ("silent chest")

  • Decreased peak expiratory flow rate

  • Inspiratory-to-expiratory ratio (normal ratios are 1:2 to 1:3)

  • Allergic shiner (dark semicircles of skin under the eyes)

  • Transverse nasal skin fold from repeatedly rubbing the nose

  • Flaring of nasal alae

  • Presence of nasal polyps and nasal secretions

  • Pulsus paradoxus (greater than a 10mm Hg difference in SBP during inspiration)

  • Murmur

  • Altered mental status

  • Clubbing