Asthma: difference between it and RAD

Could you please explain the difference between asthma and RAD? There seems to be some confusion and some people are thinking that doctors don't want to diagnose asthma, so they call the problem RAD.

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

This terminology is one of the more confusing things to understand when a child has an episode of wheezing. A parent may see one doctor who calls the wheezing reactive airways disease while another calls it asthma. How can this be? The term reactive airways disease is a catch-all diagnosis to describe many illnesses that cause a child to wheeze. Asthma is one type of reactive airways disease, but it is a specific diagnosis for a specific reason why a child is wheezing. In other words, asthma goes under the heading of reactive airways disease but so do a number of other illnesses. Many physicians wrongly call any wheezing episode in a child "asthma." However, the use of the term "asthma" may not be proper in many children who have a wheezing episode.

Can't doctors tell the difference between asthma and other forms of reactive airways disease?

Often, the answer is no. There are a number of illnesses in early childhood that mimic the symptoms of asthma. The most common of these is caused by viral infection and called bronchiolitis. Common viral illnesses that cause just a runny nose and sore throat in adults may cause wheezing in children under two years of age. The most common of these viruses is respiratory syncitial virus (RSV), but any number of viruses may cause wheezing in young children. However, most of the children recover from bronchiolitis never to have another wheezing episode while others may get another episode of bronchiolitis.

But here is where the confusion comes in: In people with asthma, the most common cause of an attack is getting a viral illness. So, when a child under two years of age gets a viral illness and has his first episode of wheezing, is this his first asthma attack, or does he have bronchiolitis? The answer to this is often unclear, so he is given the diagnosis of reactive airways disease which encompasses both asthma and bronchiolitis.

Why make the distinction? Why not just call it all asthma until you're sure it's not?

There are three main reasons why doctors are hesitant to label a child as having asthma when the diagnosis is unsure:

  1. Other illnesses such as bronchiolitis are not very responsive to medications used for asthma. So, treating these children as asthmatics only subjects them to medications they don't need.
  2. Other more serious illnesses may go undiagnosed if the reactive airways are due to other factors but just labeled as asthma. By diagnosing reactive airways disease, this leaves the door open to entertain other ideas as to the cause of the wheezing.
  3. And finally, there are many insurance companies who make obtaining health insurance difficult or very expensive if there is a child in the house with a "pre-existing condition." It would be unfortunate to label a child as asthmatic and cause insurance problems for the family when over the course of time the cause of the reactive airways disease turned out to not be asthma.

So, how do you diagnose asthma?

The definition of asthma is having airways that tend to constrict and become inflamed but are responsive to proper medication. We can't physically look at the airways in the lungs without making the patient go under general anesthesia. Therefore, doctors ask about coughing patterns and listen with the stethoscope to judge whether there is a good possibility of airway constriction and inflammation. Then, if the patient responds well to medications typically used for asthma, then the diagnosis of asthma may be right. Since this diagnosis usually can't be made on the first episode of wheezing especially in children under two years of age, it may take a couple of episodes to be confident of the diagnosis.

I hope this helps.

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