Asthma Mimickers in Children

Some conditions resemble or mimic asthma so much that healthcare providers mistake them for asthma. These conditions are called asthma mimickers. Asthma mimickers can delay your diagnosis and treatment. So your healthcare provider needs to rule out these conditions to give you an accurate asthma diagnosis. These are asthma mimickers providers only see in children.

Protracted Bacterial Bronchitis

Protracted bacterial bronchitis (PBB) ¹ is one of the most common asthma mimickers that occurs mostly in young children. Bacterial infections like streptococcus and H influenza cause PBB. The infection affects the child’s airways, resulting in these symptoms that look a lot like asthma.

• A Wet cough that lasts more than 4 weeks
• Nighttime coughing
• Shortness of breath after exercise
• Noisy breathing or chest rattling

PBB or Asthma?

PBB may cause symptoms that mimic asthma. However, there are many differences between the two conditions. Your healthcare provider may ask you these questions to help with the diagnostic process. If you answer yes to these questions, your child likely has PBB. Contact your healthcare provider for your next steps.

• Does your child have a wet, productive cough?
• Do you notice that your child’s cough gets worse when they lay down?
• Does your child experience shortness of breath after a coughing fit?
• Does your child’s chest rattle when they breathe?

Another difference between PBB and asthma is how healthcare providers treat them. Because bacterial infections cause PBB, healthcare providers prescribe antibiotics to kill the infection. Symptoms resolve 2 weeks after treatment. For asthma, healthcare providers prescribe steroid medications to help with airway inflammation and obstruction. In most cases, symptoms resolve immediately.

Airway Malacia

Airway malacia ² is another asthma mimicker that is only seen in children. Children born with airway malacia have weakness in the bone, tissue, or cartilage in their trachea. The weakness causes the affected portions of their airway to collapse. When the airway collapses, their breathing becomes partially obstructed. Children with airway malacia often have symptoms that mimic asthma:

• Persistent gasping or wheezing
• A barking cough brought on by respiratory infections
• Noisy or fast breathing
• Vomiting during feeding in infants and small children
• Vocal hoarseness or trouble producing sound due to damage

Aside from their shared symptoms, there are many differences between airway malacia and asthma. The primary difference is the cause of airway obstruction. External splinting or stenting may help to repair the physical abnormality. Your healthcare provider may recommend inhaled or oral cholinergic medications or oxygen therapy to help with their breathing.

Primary Ciliary Dyskinesia

Primarily ciliary dyskinesia (PCD) ³ is a disease that mimics asthma in children. Gene mutations affect the tiny, hair-like structures in your nose and respiratory tract called cilia. The cilia protect your airways against dirt, germs, and harmful bacteria. When the cilia do not work, germs and bacteria can enter the child’s lungs. As a result, children experience repeated infections that damage their lungs and cause these symptoms:

• A moist cough  
• Chronic nasal congestion  
• Runny nose 
• Recurring sinus and chest infections (pneumonia) 
• Breathing troubles in newborns 
• Frequent ear infections 
• Hearing loss
• Lung collapse 

The good news about PCD is that early treatment can slow your child’s lung damage by curing and limiting their infections. Your child will experience relief by:

• Using antibiotics to cure the infection
• Taking anti-inflammatory medications to get rid of their swelling
• Using chest therapies to break up the mucus in their chest
• Using bronchodilating medications to relax their airway muscles