Asthma Print An Overview of Reactive Airway Disease Scrutinizing the confusing and possibly outdated term Medically reviewed by a board-certified physician Written by twitter linkedin Written by Pat Bass, MD Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians. Learn about our editorial policy Pat Bass, MD Updated on October 16, 2019 Asthma Overview Symptoms Causes Diagnosis Treatment Coping BSIP / UIG / Getty Images In This Article Table of Contents Expand Controversy and Confusion Symptoms Causes Diagnosis Treatment View All Reactive airway disease (RAD) is a general term used to describe a reaction in which the bronchial tubes of the lungs overreact to an irritant, triggering wheezing and shortness of breath. While it's easy to assume that RAD is the same thing as asthma, RAD is actually no more than a placeholder for almost any restrictive respiratory event that has not been officially diagnosed. In other words, it's simply a classification of symptoms related to any number of conditions, including asthma, chronic obstructive pulmonary disease (COPD), and certain bronchial infections. The term RAD is most commonly applied in pediatrics when a child experiences asthma-like symptoms but is too young to undergo a bronchial challenge test or other forms of diagnostic evaluation. Controversy and Confusion While the term RAD is not meant to confuse people, it frequently does. The confusion stems in part from the term "reactive airway dysfunction syndrome (RADS)" which was coined in 1985 by American pulmonologist Stuart Brooks to describe a one-off, asthma-like reaction to smoke, fumes, or corrosive gases. Today, "occupational asthma" and "irritant-induced asthma" are more commonly applied, with some experts questioning whether RADS is even a real and distinct clinical entity. Since that time, the shortened "reactive airway disease (RAD)" has been increasingly used to describe a wide range of diseases that cause asthma-like symptoms. The problem is that it is not a medical term per se and has different definitions depending on who you speak to. Some doctors will use RAD to describe diseases that cause reversible airway narrowing, while others will include COPD, which is clearly not reversible. To add even more confusion, some—including medical professionals—will misuse RAD as a synonym for asthma. For their part, the American Academy of Allergy, Asthma, and Immunology (AAAAI) has labeled the term "imprecise" and "lazy," believing that it suggests a diagnosis in the absence of an actual investigation. Others contend that term has its appropriate usage, particularly in pediatrics or emergency care. Moreover, the very non-specificity of the classification, some argue, is meant to incite clinicians to look beyond the obvious causes and explore less common (and potentially more serious) explanations for symptoms. Symptoms You could be said to have RAD if you are experiencing wheezing, shortness of breath, and a persistent, productive cough. This cluster of symptom is triggered by a common physiological response, whether you have asthma, COPD, and other reactive respiratory conditions: Breathing restriction is caused when the smooth muscles of the lungs are hyperresponsive, cause airways to contract and narrow.Inflammation is caused when the immune system releases histamine to dilate the blood vessels in the lungs. This causes swelling and further narrowing of air passages.Excessive mucus is produced in response to both of the conditions, clogging the airways and tiny air sacs of the lungs (called alveoli). Depending on the severity of the response, symptoms can range from mild to life-threatening. Causes Again, RAD is not a diagnosis but rather a characterization of physical symptoms. It serves only as the launching point for an investigation, the direction of which can vary based on your age, medical history, symptoms, and events leading up to the attack. The shortlist of common and uncommon causes include: Aspergillosis of the lungs, a fungal infection in which asthma-like symptoms are often accompanied by the coughing up of bloodAsthma, which can occur at any age and often runs in familiesBronchiectasis, a chronic lung condition differentiated by audible crackles when breathing and finger clubbingBronchiolitis obliterans, a severe lung disease often affecting younger people who do not smokeCongestive heart failure, often accompanied by leg swelling, chest pains, and irregular heartbeatCOPD, typically associated with long-term exposure to cigarettes or toxic fumesCystic fibrosis, a congenital disease affecting children at a young age and characteristically accompanied by chronic digestive problemsGastroesophageal reflux disease (GERD), in which asthma-like symptoms are accompanied by chronic acid refluxGranutalomous lung disease, granular formations in the lungs caused by fungal or mycobacterial infections or by immune-mediated disorders like sarcoidosis or granulomatosis with polyangiitisIrritant-induced asthma, commonly affecting bakers, farmers, grain elevator operators, metal workers, plastic workers, and woodworkersPulmonary embolus, a blood clot in the lungs often occurring in people with heart disease, cancer, or who have had recent surgeryUpper respiratory viral infection, in which asthma-like symptoms are accompanied by high fever, chills, and body aches Diagnosis The approach to diagnosis is as varied as the possible causes. By and large, doctors will pursue investigations based on the diagnostic clues noted in the initial exam. These may include: Bronchoprovocation challenge testing and peak expiratory flow rate (PEFR) to help diagnose asthmaPulmonary function tests like spirometry, diffusion studies, and body plethysmography to diagnose COPDImaging tests like chest X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) to investigate heart disease, lung disease, or cancerBlood tests or cultures to detect inflammation or infectionSkin prick and RAST blood tests to identify allergy triggersLung biopsy to help evaluate suspicious tissue growthsAntinuclear antibody (ANA) blood tests to help diagnose autoimmune diseaseCF gene mutation panel to diagnose cystic fibrosisEndoscopy, in which a viewing scope is inserted into the windpipe to determine whether acid reflux is a cause In pediatric cases, RAD may be notated in the infant's medical records if no apparent cause is found in the early investigation. The aim of the notation is to ensure that the baby's condition is monitored until such time as more definitive diagnostic tools can be used. Treatment There are no clear treatment guidelines for reactive airway disease. In emergency situations, the classification would help direct rescue efforts, which may include: Emergency oxygen therapyPulse oximetry to assess oxygen blood saturationInhaled rescue bronchodilators (or intravenous bronchodilators in severe cases)Epinephrine injections if symptoms are suggestive of potentially life-threatening allergic anaphylaxis In such situations, the term RAD provides emergency room staff with a shorthand of symptoms once the patient is delivered by ambulance personnel. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Academy of Allergy, Asthma, and Immunology. Definition of Reactive Airway Disease. Milwaukie, Wisconsin; issued October 1, 2014. Brooks, S.; Weiss, M.; and Bernstein, I. Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures. Chest. 1985;88(3):376-84. Brooks, S. Then and Now Reactive Airways Dysfunction Syndrome. J Occupation Environ Med. 2016;58(6):636-7. DOI: 10.1097/JOM.0000000000000787. Douglas, L. and Feder, K. RAD: Reactive Airways Disease or Really Asthma Disease? Pediatrics. 2017;139(1). DOI: 10.1542/peds.2016-0625. Continue Reading