a) Diagnostic confusion in an infant presenting with wheezing as bronchiolitis or viral bronchopneumonia or wheezing due to asthma.

b) Why only first time wheezers were defined as bronchiolitis? Although in the American Academy of Pediatrics guidelines [2], they have refrained from using word ‘first time wheezing’.

c) Most common cause of bronchiolitis in developed [3] as well as developing countries [4] is Respiratory Syncytial Virus (RSV) which does not respond to bronchodilators or steroids – the two main therapies otherwise employed in treatment of wheezy infants. In most of the infants presenting with moderate to severe respiratory distress needing hospitalization, use of bronchodilator nebulization, and often steroids is common practice to relieve distress besides giving oxygenation and other supportive measures like intravenous fluids, irrespective of diagnosis. There is recommendation for trial of bronchodilator rather than routine use [1,2]. But still there is hesitation in keeping sick babies only on oxygen therapy despite clinically diagnosing them as bronchiolitis. Although hypertonic saline nebulization [5] and nasal Continuous Positive Airway Pressure (CPAP) appear to have potential beneficial effect, more studies are needed to recommend their routine use.

d) As virological and radiological work-up is neither required nor easily available for diagnosis, therapy is mainly based on clinical condition at the time of admission. Although saturation by pulse oximetry is considered deciding factor for giving oxygen therapy, it cannot be taken as sole criteria. Are there any validated clinical scores for diagnosis and monitoring of such children?