Diagnosis of wheezing in children

Respiratory Noises: How Useful are They Clinically? (2009)

“Although clinicians place considerable weight on the identification of the various forms of noisy breathing, there are serious questions regarding both the accuracy (validity) and the reliability (repeatability) of these noises. To avoid diagnostic errors, clinicians need to consider the whole constellation of symptoms and signs, and not focus on the specific “type” of noise. Given the high error rate with “parent-reported wheeze” there is a need to reexamine the extensive literature on the epidemiology of wheeze in infants and young children, because parent-reported wheeze is unconfirmed by a clinician. It is obvious we need more high-quality research evidence to derive better evidence on the clinical utility of these noises, and their natural history.”

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Differential diagnosis and treatment of wheezing and asthma in young children. (2008)

“Establishing a diagnosis of asthma in young wheezing patients can be challenging because the type, severity, and frequency of asthma signs and
symptoms vary widely among, and sometimes within, individual children. Knowing when and how to treat episodic wheeze, assessing the risk of asthma progression in wheezing patients, choosing the most
effective controller regimen in patients once asthma is diagnosed, and deciding when to terminate controller therapy also can be difficult decisions for physicians. This review provides literature-based and clinical experience-based recommendations for the management of wheeze and diagnosis and management of asthma in young children.”

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The diagnosis of wheezing in children. (2008)

“Wheezing in children is a common problem encountered by family physicians. Approximately 25 to 30 percent of infants will have at least one wheezing episode, and nearly one half of children have a history of wheezing by six years of age. The most common causes of wheezing in children include asthma, allergies, infections, gastroesophageal reflux disease, and obstructive sleep apnea. Less common causes include congenital abnormalities, foreign body aspiration, and cystic fibrosis. Historical data that help in the diagnosis include family history, age at onset, pattern of wheezing, seasonality, suddenness of onset, and association with feeding, cough, respiratory illnesses, and positional changes. A focused examination and targeted diagnostic testing guided by clinical suspicion also provide useful information. Children with recurrent wheezing or a single episode of unexplained wheezing that does not respond to bronchodilators should undergo chest radiography. Children whose history or physical examination findings suggest asthma should undergo diagnostic pulmonary function testing.”

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The wheezing infant: diagnosis and treatment. (2003)

1. Describe the natural history of the wheezing infant once other underlying causes of wheezing have been ruled out.

2. Determine factors that can be determined on history that increase the risk of persistent asthma in a wheezing infant.

3. In children with an increased risk for persistent asthma, describe factors that have been associated with a better response to inhaled corticosteroids.

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