We have had all kinds of cough in the office this season…croupy, wet, hacking, acute, chronic, viral and reactive. Some of these descriptions are also diagnoses. Often parents tell me it’s hard to understand the meaning behind the words. A great example of this difficulty is the often interchanged and similar but distinct diagnoses of reactive airway disease and asthma.
Wheezing and persistent cough are common to both of these illnesses. The main distinction between them is the frequency of symptoms and their etiology. Children with asthma will show themselves over time by developing wheezing, cough or shortness of breath. This is in response to a wide variety of agents--from grass to perfume, to cold, to illnesses--and this happens recurrently.
Those with reactive airway disease are generally first time or infrequent wheezers. It is unknown whether or not they will repeat their current symptoms with another illness. So they are coined reactive. The diagnoses do not correspond to how quickly or to what severity a child develops these symptoms. Although it is true that RAD can be used as a diagnosis at any age, infants are commonly given this description just by the nature that they have not been around as long!
The reason that I believe it is important to acknowledge and try to describe the differences between these two terms is to help parents understand what is going on with their child. Many a time, when I tell a parent their child has asthma, they quickly respond, “No, it’s just reactive airways”. The diagnosis of asthma seems to connote a sickly or incapable child. This is certainly not the case, as many Olympians have had asthma.
What the asthma distinction does allow is an ability for a parent to interpret their child’s symptoms and manage them to avoid emergency room visits, secondary complications, and missed school days. Preventive management is also a possibility with children who are asthmatic, whereas reactive airway disease by its nature is a surprise response.
While there have been discussions about limiting these terms to correlate with particular age groups, I believe the above descriptions are a straightforward and educational way to look at both diagnoses and how they are commonly applied in medical practice. Hope it makes sense to you!