Simple predictors to differentiate acute respiratory infections from acute asthma in children 6 months to 5 years


  • Krithika Manikumar Department of Paediatrics, Sree Balaji Medical College and Hospital, Chrompet, Chennai, Tamilnadu, India
  • Pooja Pradeep Department of Paediatrics, Sree Balaji Medical College and Hospital, Chrompet, Chennai, Tamilnadu, India
  • R. Somasekar Department of Paediatrics, Sree Balaji Medical College and Hospital, Chrompet, Chennai, Tamilnadu, India



Antibiotics, Asthma, Bronchodilator, Pneumonia, Simple Predictors, WHO Criteria


Background: Acute respiratory infections constitute one of the principal causes of morbidity and mortality in children less than five years of age in developing countries. For logistic reasons, WHO recommended case management is structured towards treatment as pneumonia in preference to acute asthma. It is warned that wheezing can occur during pneumonia and therefore, care must be taken when treating wheezing not to miss treating pneumonia with an antibiotic. Current WHO ARI CASE MANAGEMENT guidelines, in a child presenting with cough and rapid breathing, there is a predilection for over -treatment of pneumonia and under treatment of asthma.

Methods: Totally 245 children were included in the study. They were classified into asthmatic and LRI prone with the help of simple predictors.

Results: The combination of fever, chest indrawing and persistent tachypnoea after bronchodilator has an excellent specificity of 96.12% in predicting the presence of pulmonary infiltrate. The presence of more than two episodes of similar respiratory distress, previous H/O of nebulization and family H/O asthma, either alone or in combination may point more towards asthma as a cause of cough and respiratory distress.

Conclusions: In a child presenting with cough and fast breathing with a previous similar episode, trial nebulization can be given before investigating further for pneumonia.


Report of consultative meeting to Review Evidence and Research priorities in the management of Acute respiratory Infections. Geneva. World Health Organisation, 29 Sepl Oct 2003. WHO/FCH/CAH/04.2

World Health Organization. Programme of Acute Respiratory Infections. (‎1990)‎. Acute respiratory infections in children: case management in small hospitals in developing countries, a manual for doctors and other senior health workers. World Health Organization. Available at: Accessed 16 June 2019.

World Health Organization. "Revised WHO classification and treatment of pneumonia in children at health facilities: evidence summaries." 2014.

Nascimento-Carvalho CM. Control of Respiratory Infections. In: Gupte S. Recent Advances in Pediatrics – 13; 2003:159-174.

Torzillo PJ. Wheezing and the management algorithms for pneumonia in developing countries. Ind Pediatr. 2001;38:821-6.

World Health Organization & United Nations Children's Fund (‎‎UNICEF)‎‎. (‎1986)‎. Basic principles for control of acute respiratory infections in children in developing countries / a joint WHO/UNICEF statement. World Health Organization. Available at: Accessed 16 June 2019.

Hsieh KH, Shen JJ. Prevalence of childhood asthma in Taipei, Taiwan and other Asian Pacific countries. J Asth. 1988;25:73- 82.

Kun HY, Oates RK, Mellis CM. Hospital admissions and attendances for asthma - a true increase? Med J Aust. 1993;159:312-3.

Carman PG, Landau LL Increased pediatric admissions with asthma in Western Australia - A problem of diagnosis. Med J Austr. 1990;152:23-6.

Chew FT, Goh DYT, Lee BW. Epidemiological surveys on the prevalence of childhood asthma, rhinitis and eczema worldwide. Singap Pediatr J. 1996;38:74-96.

Juel K, Pendersen PA. Increased asthma mortality in Denmark 1968-88 not a result of changed coding practice. Ann Aller.1992;68:180-2.

Ingle G K, Malhotra C. Integrated management of neonatal and childhood illness: An overview. Indian J Community Med. 2007;32:108-10.

Bronchodilators and Other Medication for the Treatment of Wheeze Associated Illnesses in Young Children. Programme for Control of Acute Respiratory Infections, Geneva, World Health Organization, Document WHO/ARI/93.29,1993.

World Health Organization. (‎2005)‎. Technical updates of the guidelines on the Integrated Management of Childhood Illness (‎IMCI)‎: evidence and recommendations for further adaptations. World Health Organization. Available at: Accessed 16 June 2019.

Sachdev HPS, Vasanthi B, Satyanarayana L, Simple predictors to differentiate acute asthma from ARI in children: Implications for refining case management in the ARI Control Programme. Ind Pediatr. 1995;31:1251-9.

Sachdev HPS, Mahajan SC, Garg A. Improving antibiotic and bronchodilator prescription in children presenting with difficult breathing: experience from an urban hospital in India. Ind Pediatr. 2001;38:827-38.

Castro AV, Nascimento-Carvalho CM, Ney-Oliveria F, Araujo­ Neto CA, Andrade SC, Loureiro LL, et al. Additional markers to refine the World Health Organization algorithm for diagnosis of pneumonia. Ind pediatr. 2005;42:773-80.

Baquero F, Martinez-Beltran J, A review of antibiotic resistance patterns of Streptococcus pneumoniae. Europe J Antimic Chemo. 1991;28:31-8.

Klugman KP. Pneumococcal resistance to antibiotics. Clin Microbiol Rev.1990;34:171-96.

Mastro TD, Ghafoor A, Nomani NK, Ishaq Z, Anwar F, Granoff DM, et al. Antimicrobial resistance of pneumococci in children with acute lower respiratory tract infection in Pakistan. Lancet. 1991;337:156-9.






Original Research Articles