Pediatric Pulmonology
Core concepts
Understand asthma as a chronic inflammatory disease with reversible obstruction: diagnosis by pattern and response to bronchodilator, severity by symptom frequency and lung function, and management by stepwise inhaled corticosteroids. Know the differential for chronic cough (upper airway cough syndrome, asthma, GERD, foreign body, pertussis), the approach to recurrent pneumonia (aspiration, immunodeficiency, structural), and cystic fibrosis (sweat chloride, newborn screening, pancreatic insufficiency). Master the interpretation of spirometry - obstructive versus restrictive patterns and bronchodilator response.
Traps
Questions present a child with recurrent wheeze and expect you to consider foreign body, vascular ring, or tracheomalacia before labeling asthma. Another trap is over-relying on a single normal chest radiograph. Do not confuse the acute exacerbation management (oxygen, inhaled bronchodilators, systemic steroids) with the chronic controller plan. Recognize that a child with CF can present with meconium ileus, failure to thrive, or clubbing.
Worked example
A 3-year-old with sudden onset of unilateral wheeze and cough after playing with small toys should be evaluated for an inhaled foreign body; the correct next step is a chest radiograph (which may be normal) followed by bronchoscopy if suspicion remains, not escalation of asthma therapy.
Rule of thumb
Wheeze that is unilateral, sudden, or unresponsive to bronchodilators should prompt a search for a structural or foreign-body cause before asthma is diagnosed.