[Asthma in the young child: when should inhaled foreign body be suspected?]

Many young children and infants wheeze during viral infections of the respiratory tract. The differential diagnosis of those children includes the inhalation of a foreign body. This diagnosis is overlooked in about 20% of cases, which leads to subacute and chronic complications. Two clinical observations are reported, involving young children with clinical asthma exacerbations but where the absence of response to usual treatment and/or the absence of evidence for atopy and/or the acute onset brought us to suspect the inhalation of a foreign body. These cases allow us to remind the usual signs and symptoms associated with the inhalation of a foreign body. Amongst these signs, unilateral hypoventilation on chest auscultation associated with localized emphysema on chest x-ray has a very high positive predictive value. Aggressive management in a specialized surrounding is advocated when an inhaled foreign body is suspected. Algorithms based on the level of suspicion have been designed to allow the pediatric respiratory physician to choose between rigid and fiberoptic bronchoscopy. It is only by systematization of these procedures and development of preventive measures that we will be able to reduce the prevalence of complications secondary to the inhalation of a foreign body.