Stridor in Children with Asthma
No, children with asthma do not typically develop true inspiratory stridor, and the presence of stridor should prompt immediate investigation for alternative or additional diagnoses. 1
Key Distinction: Wheeze vs. Stridor
Asthma produces expiratory wheeze, not inspiratory stridor. The British Thoracic Society explicitly states that wheeze should be "distinguished from upper airway noises" when evaluating children for asthma. 1
Acoustic Differences:
- Wheeze (asthma): Predominantly expiratory, polyphonic, heard best over the chest, caused by lower airway turbulence 1, 2
- Stridor: Predominantly inspiratory, monophonic/musical, heard best over the neck, caused by upper airway obstruction 2, 3
Critical Clinical Implication
The presence of inspiratory stridor in a child being evaluated for asthma is an "unexpected clinical finding" that mandates specialist referral. 1
The British Thoracic Society guidelines specifically list "inspiratory stridor" as an indication for urgent referral for specialist opinion and further investigation, alongside other red flags like abnormal voice/cry, dysphagia, and focal chest signs. 1
Common Misidentification by Parents
Parents frequently mislabel stridor and upper airway rattles as "wheeze." 1
The European Respiratory Society acknowledges that caregivers often confuse these sounds, and the term "wheeze" lacks equivalent translations in many languages, contributing to diagnostic confusion. 1 This is why clinical auscultation by a healthcare professional is essential—asthma should be suspected when wheeze is "ideally heard by a health professional on auscultation, and distinguished from upper airway noises." 1
When Stridor Occurs: Alternative Diagnoses
If true inspiratory stridor is present in a child with respiratory symptoms, consider:
- Upper airway obstruction: Laryngomalacia, tracheomalacia, croup, foreign body aspiration 4, 3
- Laryngeal/tracheal pathology: Vocal cord dysfunction, subglottic stenosis 5, 3
- Structural abnormalities: Vascular rings, mediastinal masses 5, 3
- Neurological causes: Chiari malformation with vocal cord paralysis 6
Practical Approach
If you hear inspiratory stridor in a child being evaluated for asthma:
- Stop and reconsider the diagnosis—this is not typical asthma 1
- Refer urgently for specialist evaluation and likely flexible airway endoscopy 1, 3
- Do not empirically treat with asthma medications until upper airway pathology is excluded 1
Asthma and upper airway obstruction can coexist, but stridor itself is not a manifestation of asthma and requires separate investigation. 5