Evaluation of the wheezy infant (original) (raw)
Related papers
American Journal of Respiratory and Critical Care Medicine, 2016
Background: Infantile wheezing is a common problem, but there are no guidelines for the evaluation of infants with recurrent or persistent wheezing that is not relieved or prevented by standard therapies. Methods: An American Thoracic Society-sanctioned guideline development committee selected clinical questions related to uncertainties or controversies in the diagnostic evaluation of wheezing infants. Members of the committee conducted pragmatic evidence syntheses, which followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The evidence syntheses were used to inform the formulation and grading of recommendations. Results: The pragmatic evidence syntheses identified few studies that addressed the clinical questions. The studies that were identified constituted very low-quality evidence, consisting almost exclusively of case series with risk of selection bias, indirect patient populations,
Persistent Wheeze in Infants: A Guide for General Pediatricians
Pediatric Annals, 2019
Infants with persistent wheeze is a common diagnostic challenge for the general pediatrician because of the broad differential diagnoses. The initial diagnostic approach should include a comprehensive history, physical examination, and chest radiography. Additional testing may be warranted. Involvement of a pediatric pulmonary subspecialist may also be indicated. [Pediatr Ann. 2019;48(3):e110-e114.]
A Cost-Effective Approach to the Diagnosis and Treatment of the Wheezing Infant
Allergy and Asthma Proceedings, 1997
Wheezing in infancy presents the clinician with at least two broad clinical problems. First is the task of distinguishing the' common entities of bronchiolitis and asthma from rare, yet potentially life threatening illnesses that may present with wheezing. The second problem deals with the difficulties in distinguishing an infant with an isolated episode of wheezing with an upper respiratory tract infection from those infants who are at risk for persistence of wheezing through infancy. When confronted with a wheezing infant, a family may appropriately have the following questions: Is this asthma? What testing is needed? What risk for recurrence is present? A physician may focus similarly on the issue of risk of persistence of wheezing and be left with the difficult decisions of the cost and benefit of different diagnostic and therapeutic modalities. In order to best address these questions, a brief review of the pathophysiology, clinical, and epidemiological features associated with wheezing in infancy is offered. (Allergy and Asthma Proc 18: 149-152, 1997) WHAT IS WHEEZING? W heezing is thought of as a subjective musical finding. It is characterized by the length (>200 msec) and the character of the sound resulting from turbulence of airflow through narrowed tubes. The mechanisms producing airway narrowing include accumulation of secretions, interstitial edema, muscular contractions, and airway collapse from either intrinsic or extrinsic causes. If tubes of various diameters are affected, the resulting chorus of airflow turbulence
Epidemiological aspects of and risk factors for wheezing in the first year of life
Jornal Brasileiro de Pneumologia, 2014
OBJECTIVE: To determine, in a sample of infants, the prevalence of and risk factors for occasional wheezing (OW) and recurrent wheezing-wheezy baby syndrome (WBS). METHODS: Parents of infants (12-15 months of age) completed the International Study of Wheezing in Infants questionnaire. RESULTS: We included 1,269 infants residing in the city of Blumenau, Brazil. Of those, 715 (56.34%) had a history of wheezing, which was more common among boys. The prevalences of OW and WBS were 27.03% (n = 343) and 29.31% (n = 372), respectively. On average, the first wheezing episode occurred at 5.55 ± 2.87 months of age. Among the 715 infants with a history of wheezing, the first episode occurred within the first six months of life in 479 (66.99%), and 372 (52.03%) had had three or more episodes. Factors associated with wheezing in general were pneumonia; oral corticosteroid use; a cold; attending daycare; having a parent with asthma or allergies; mother working outside the home; male gender; no br...
Pediatric Allergy and Immunology, 2019
Background. Data addressing short-and long-term respiratory morbidity in moderate-late preterm infants is limited. We aim to determine the incidence of recurrent wheezing and associated risk and protective factors in these infants during the first 3 years of life. Methods. Prospective, multicenter birth cohort study of infants born at 32 +0 to 35 +0 weeks' gestation and followed for 3 years to assess the incidence of physician-diagnosed recurrent wheezing. Allergen sensitization and pulmonary function were also studied. We used multivariate mixed-effects models to identify risk factors associated with recurrent wheezing. Results: 977 preterm infants were enrolled. Rates of recurrent wheezing during year (Y)1 and Y2 were similar (19%) but decreased to 13.3% in Y3. Related hospitalizations significantly declined from 6.3% in Y1 to 0.75% in Y3. Independent risk factors for recurrent wheezing during Y2 and Y3 included: day care attendance, acetaminophen use during pregnancy and need for mechanical ventilation. Atopic dermatitis on Y2 and male sex on Y3 were also independently associated with recurrent wheezing. Palivizumab prophylaxis for RSV during the first year of life, decreased the risk or recurrent wheezing on Y3. While there were no differences in rates of allergen sensitization, pulmonary function tests (FEV 0.5) were significantly lower in children who developed recurrent wheezing. Conclusions. In moderate-to-late premature infants, respiratory symptoms associated with lung morbidity persisted during the first 3 years of life and were associated with abnormal pulmonary function tests. Only anti-RSV prophylaxis exerted a protective effect in the development of recurrent wheezing.
Reported versus confirmed wheeze and lung function in early life
Archives of Disease in Childhood, 2004
Aims: To investigate the relation between parentally reported wheeze (unconfirmed), physician confirmed wheeze, and subsequent lung function. Methods: Children at risk of allergic disease (one parent atopic) were recruited antenatally and followed prospectively from birth. During the first three years of life parents were asked to contact the study team if their child was wheezy. The presence of wheeze was confirmed or not by the primary care or study physician. Respiratory questionnaire and specific airway resistance measurement (sR aw , body plethysmograph) were completed at age 3 years. Results: A total of 454 children were followed from birth to 3 years of age. One hundred and eighty six (40.9%) of the parents reported their child wheezing in the first three years of life, and in 130 (28.6%) the wheeze was confirmed. A total of 428 children attended the three year clinic review, of whom 274 (64%) successfully carried out lung function tests. There was no significant difference in sR aw (kPa?s; geometric mean, 95% CI) between children who had never wheezed (n = 152; 1.03, 1.00 to 1.06) and those with a parentally reported but unconfirmed wheeze (n = 36; 1.02, 0.96 to 1.07, p = 1.00). sR aw was significantly higher in children with a physician confirmed wheeze (n = 86; 1.17, 1.11 to 1.22, p , 0.001) compared to those with no history of wheeze or with unconfirmed wheeze. Conclusions: Children with physician confirmed wheeze have significantly poorer lung function compared to those with parentally reported but unconfirmed and those who have never wheezed. A proportion of parents may have little understanding of what medical professionals mean by the term ''wheeze''.
Lung structure and function of infants with recurrent wheeze when asymptomatic
European Respiratory Journal, 2009
Infants with recurrent wheeze have repeated episodes of airways obstruction; however, relatively little is known about the structure and function of their lungs when not symptomatic. The current authors evaluated whether infants with recurrent wheeze have smaller airway lumens or thickened airway walls, as well as decreased airway function. High-resolution computed tomography images 1 mm thick were obtained at three anatomic locations at an elevated lung volume and at functional residual capacity. Forced expiratory flows were also measured in subjects with recurrent wheeze. Airway lumen, wall areas and lung tissue density were not significantly different for recurrent wheeze (n517) and control (n514) subjects; however, subjects with recurrent wheeze had lower forced expiratory flows than predicted. Similar findings were obtained when subjects were grouped by exposure to tobacco smoke. These findings indicate that infants with recurrent wheeze, as well as exposure to tobacco smoke, have lower airway function when not symptomatic. The lower forced expiratory flows may result from a degree of airway narrowing that could not be resolved with the methodology employed or from other mechanisms, such as more collapsible airways or decreased pulmonary elastic recoil.