The Wheezing Infant in December: Bronchiolitis vs Asthma

Presentation

A previously healthy 9-month-old is brought to the ED in mid-December with 3 days of nasal congestion, cough, and low-grade fever, now with worsening work of breathing and reduced feeding (roughly half of normal intake). This is his first-ever episode of wheezing, and several children at his daycare have had colds. He has no personal or family history of asthma or atopy.

T 38.0°C, HR 150, RR 60, BP 88/54, SpO2 91% on room air, weight 9 kg; exam: diffuse bilateral wheezes and fine crackles, mild subcostal retractions, wet cough with copious nasal secretions.