The Wheezing Child: Children'S Interstitial Lung Disease - A Rare But Important Differential Diagnosis In Children With Severe Wheeze

Children's interstitial lung disease' (chILD) is an umbrella term for disorders that mainly affect the lung parenchyma and lead to impaired alveolar gas exchange. The main symptoms are tachypnoea, hypoxaemia, retractions, crackles and failure to thrive. Even though wheeze is not a common symptom of chILD, there are various disorders which also affect the conducting airways, leading to bronchial obstruction in some children. Therefore, chILD has to be considered, especially in children with severe persistent wheeze refractory to asthma treatment and after the exclusion of more common causes. The aim of this article is to give an overview of the clinical symptoms, present the current classification scheme of chILD and describe examples of selected disorders which can present with wheeze. Furthermore, suggestions for diagnostic approaches for children with persistent bronchial obstruction and suspected diffuse lung disease are given.