Wheezing is a common condition in pediatric practice, it can be defined as a musical sound, high-pitched and continuous, emitting from the chest during breath exhalation. Although almost 50% of children experiences wheeze in the first 6 years of life, only 40% of them will report continued wheezing symptoms after childhood. The classification of wheeze in preschool children is more difficult compared to school aged children. It is based on the onset and duration of symptoms and divided children in three categories: transient early wheezing, non-atopic wheezing and atopic wheezing/asthma. History and physical examination, skin prick test, exhaled nitric oxide, lung function test are the parameter to evaluate children with wheezing. The aim of management of wheezing is to finalize the control of symptoms, reduce exacerbations and improve the quality of life. All guidelines underline the complexity in making a diagnosis of asthma under five years and the need to identify phenotypes that may help paediatricians in the therapeutic choices.
Fractional exhaled NO (FeNO) is universally considered an indirect marker of eosinophilic airways inflammation, playing an important role in the physiopathology of childhood asthma. Advances in technology and standardization have allowed a wider use of FeNO in clinical practice in children from the age of four years. FeNO measurements add a new dimension to the traditional clinical tools (symptoms scores, lung function tests) in the assessment of asthma. To date a number of studies have suggested a possible use of FeNO in early identification of exacerbation risk and in inhaled corticosteroids titration. The aim of this paper is to address practical issues of interest to paediatric clinicians who are attempting to use FeNO measurements as an adjunctive tool in the diagnosis and management of childhood airway diseases.
HyperCKemia and rhabdomyolysis are sides of the same coin. In pediatric age, in most cases, the etiology is infectious in origin with a favorable course. However, the persistence of elevated CK values over time should lead to suspicion of genetic/ hereditary causes that may also require the involvement of other specialists. Rhabdomyolysis is an urgent concern because of the possible evolution into acute renal failure requiring appropriate fluid management and aggressive treatment of electrolyte disorders.
Pediatric acute ataxia generally represents an infrequent occurrence of pediatric emergency department access, but the broad differential diagnosis concerning it requires, starting with anamnesis and objective examination, to mainly exclude life-threatening causes in the child. For these reasons, the diagnosis of acute post infectious cerebellar ataxia, a benign and self-limiting form, which is the underlying cause in most cases of acute ataxia must always be a diagnosis of exclusion. The broad differential diagnosis also requires a correct approach that must consider the setting about the use of imaging techniques proportional to the urgency, in order to reduce the risk of unnecessary radio exposure. Starting from this, we have attempted to summarize the literature regarding the clinical history, physical examination, and diagnostic tests necessary to arrive at a correct diagnosis.
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