What is the definition of reactive airway disease in a child under 5 years of age with recurrent wheezing, coughing, or shortness of breath?

Reactive Airway Disease Definition

"Reactive airway disease" (RAD) is not a valid medical diagnosis and should be avoided—it is a vague descriptive term that delays appropriate asthma diagnosis and treatment in children with recurrent wheezing. 1, 2, 3

Why This Term Should Be Abandoned

The term "reactive airway disease" lacks a specific ICD-10 code and represents a clinical observation rather than a definitive diagnosis. 3 Major pediatric guidelines explicitly recommend against using labels like "wheezy bronchitis," "recurrent pneumonia," or "reactive airway disease" because these terms:

• Delay proper asthma diagnosis and treatment, missing the opportunity to reduce morbidity in children who have chronic airway inflammation and structural changes developing in the preschool years 1
• Result in delayed delivery of preventive care measures including controller medications and asthma action plans, with children receiving these interventions an average of 9 months later than those diagnosed with asthma 4
• Create confusion in communication between providers, patients, and families about the actual condition being treated 4

What RAD Actually Represents Clinically

When clinicians use "reactive airway disease," they typically mean one of two distinct conditions:

1. Viral-Induced Wheezing in Young Children

• Transient wheezing episodes triggered by viral respiratory infections, particularly RSV bronchiolitis 5
• Approximately 90% of children with viral bronchiolitis are cough-free by day 21 2
• These children should not be treated with asthma medications unless they have recurrent wheezing (>3 episodes in the previous year) and risk factors for persistent asthma 2

2. Undiagnosed or Suspected Asthma

• Children with recurrent episodes of wheeze, cough, and breathing difficulty who have not yet undergone objective testing 1
• Asthma is defined as a disease that includes symptoms of wheeze, cough, and breathing difficulty together with reversible airways obstruction, airway inflammation, and bronchial hyperresponsiveness 1

Proper Diagnostic Approach for Children Under 5 Years

Key symptoms to identify:

• Recurrent wheeze (heard by caregiver or on auscultation) is the most important symptom of asthma 1, 2
• Cough and breathing difficulty that vary over time and intensity 1
• Symptoms triggered by viral infections, exercise, allergens, or cold air 3

Risk factors for persistent asthma:

• Atopic features: eczema, food allergies 2, 3
• Family history of asthma 2, 3
• More than 3 wheezing episodes in the previous year 2

Critical distinction:

• Children with chronic cough (>4 weeks) as the only symptom are unlikely to have asthma and should be investigated according to chronic cough guidelines 1, 2
• Asthma should never be diagnosed based on symptoms alone—objective testing is required when age-appropriate 2

Recommended Terminology Instead

For children under 5 years:

• Use "suspected asthma" or "probable asthma" when recurrent wheezing is present with risk factors 1
• Use "viral-induced wheeze" for isolated wheezing episodes associated with viral infections without other asthma features 2
• Use ICD-10 code J45.9 (Asthma, unspecified) when asthma is suspected but not definitively confirmed 3

For children 5 years and older:

• Pursue objective testing with spirometry and bronchodilator reversibility 1
• Diagnose "asthma" with appropriate severity classification (mild intermittent, mild persistent, etc.) based on symptoms, pulmonary function, and medication requirements 3

Common Pitfalls to Avoid

• Never use RAD as a "safer" or "less committal" diagnosis—this delays appropriate treatment and worsens outcomes 1, 4
• Do not prescribe asthma medications for isolated post-viral cough lasting >4 weeks without documented recurrent wheezing or dyspnea 2, 6
• Avoid empirical long-term asthma treatment without monitoring response—if initiating inhaled corticosteroids, stop treatment if no clear benefit is seen within 4-6 weeks 2
• Remember that approximately 50-80% of children with asthma develop symptoms before age 5, but not all early wheezers develop persistent asthma—the natural history is highly variable 2