GG Joag, Megha Rustagi
Department of Paediatrics, Krishna Institute of Medical Sciences (Deemed to be University), Karad, Maharashtra, India.
Background: Differentiating acute respiratory distress and wheezing in infants is difficult due to similar clinical presentations. Therefore, it is of utmost importance to diagnose and differentiate bronchopneumonia, bronchiolitis, and bronchial asthma on the basis of clinical parameters in infants. Materials and Methods: One hundred infants with fever, cough, and increased respiratory distress with wheezing were included, and detailed clinical history, allergic disorder, immunization status were collected. Study cases were diagnosed as bronchopneumonia, bronchiolitis, or bronchial asthma based on clinical criteria, and a suitable treatment regimen was provided. Chi-square test, Fisher’s exact test, and two-sample proportion test were used to analyze the data. Results: Among 100 cases, 50% of cases were of bronchopneumonia, whereas 36% and 14% of cases were of bronchiolitis and bronchial asthma. A significant difference was observed among them for the history of wheezing (P = 2.839e-12), presentation of various signs and symptoms (P = 0.00), and treatment regimens. The odds of occurrence of bronchopneumonia was more with the signs of flaring of alae nasi and palpable liver (OR=[0.62–4.32]; and [0.63–4.14]). For bronchiolitis also, it was higher if they showed signs of tachycardia, pallor, and reduced breathing sounds (OR = [0.96–6.8679]; [0.44–2.76]; and [0.70–5.44]). Furthermore, for bronchial asthma, it was higher if it presented the signs of tachycardia, cyanosis, reduced breathing sounds, palpable spleen, etc., (OR = [0.90–16.18]; [1.93–36.50]; [0.43–6.92]; and [0.17–11.52]). Ampicillin and gentamicin treatment regimen for bronchopneumonia; salbutamol and intravenous fluids for bronchiolitis; and steroids and salbutamol for bronchial asthma were the choice of treatment. Conclusion: The study demonstrated the differential diagnosis of bronchopneumonia, bronchiolitis, and bronchial asthma based on clinical features and will be useful in the rational management of these conditions.
Keywords: Bronchial asthma, bronchiolitis, bronchopneumonia, infants, wheezing.