524 Reccurent Wheezing in Childhood—Is It Always Asthma?

BACKGROUND: Clinical presentation of the bronchial obstruction in children is most often highly suggestive of bronchiolitis, recurrent wheezing or asthma. METHODS: We present the cases of 2 patients diagnosed with recurrent bronchiolitis and asthma, non-responsive to treatment. RESULTS: The first patient, a 9-year-old boy presented wheezing, non-productive cough, dyspnea, aquous rhinorrhea, sneezing and nasal itching interpreted as allergic asthma associated to allergic rhinitis as he was sensitized to house-dust mites and dog. A treatment with inhaled corticosteroids and antihistamine was prescribed with little improvement of asthma symptoms. Six months later the patient presented for vomiting and productive cough. Thoracic ultrasound suggested achalasia, diagnosis confirmed through esophageal manometry and barium swallow. Surgical treatment led to resolution of asthma-like symptoms with persistence of a mild intermittent rhinitis. In the second case, a female patient presented 2 episodes of uncomplicated bronchiolitis during the 6th and the 7th month of life and a 3rd episode of bronchiolitis complicated with pneumonia during the 8th month of life. When admitted for the 3rd episode, she presented an oxygen saturation of 91% in ambient air. Thoracic ultrasounds oriented the diagnosis towards a diaphragmatic hernia, confirmed through barium swallow and barium enema. The surgical treatment of the hernia determined the resolution of respiratory symptoms. Unfavourable clinical course, despite correct treatment in both cases required additional investigations which finally led to the correct diagnosis and treatment. CONCLUSIONS: For the differential diagnosis of non-responsive bronchial obstruction in children, one must think to digestive diseases. Ultrasound was the elective non-invasive method in diagnosing our cases.