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Pasterkamp H. The highs and lows of wheezing: A review of the most popular adventitious lung sound. Pediatr Pulmonol 2018; 53:243-254. [PMID: 29266880 DOI: 10.1002/ppul.23930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/26/2017] [Indexed: 12/22/2022]
Abstract
Wheezing is the most widely reported adventitious lung sound in the English language. It is recognized by health professionals as well as by lay people, although often with a different meaning. Wheezing is an indicator of airway obstruction and therefore of interest particularly for the assessment of young children and in other situations where objective documentation of lung function is not generally available. This review summarizes our current understanding of mechanisms producing wheeze, its subjective perception and description, its objective measurement, and visualization, and its relevance in clinical practice.
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Verheggen M, Wilson AC, Pillow JJ, Stick SM, Hall GL. Respiratory function and symptoms in young preterm children in the contemporary era. Pediatr Pulmonol 2016; 51:1347-1355. [PMID: 27228468 DOI: 10.1002/ppul.23487] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/14/2016] [Accepted: 04/24/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the relationships between respiratory symptoms, lung function, and neonatal events in young preterm children. METHODS Preterm children (<32 w gestation), classified as bronchopulmonary dysplasia (BPD) or non-BPD, and healthy term controls were studied. Lung function was measured by forced oscillation technique (respiratory resistance [Rrs] and reactance [Xrs]) and spirometry. Respiratory symptom questionnaires were administered. RESULTS One hundred and fifty children (74 BPD, 44 non-BPD, 32 controls) 4-8 years were studied. Lung function (median Z-score [10,90th centile]) was significantly impaired in preterm children compared to controls for FVC (0.00 [-1.18, 1.76], 0.69 [-0.17,1.86]), FEV1 (-0.44 [-1.94, 1.11], 0.49 [-0.83, 2.51]), Xrs (-1.26 [-3.31, 0.11], -0.11 [-0.97, 0.73]), and Rrs (0.55 [-0.48, 1.82], 0.28 [-0.99, 0.96]). Only Xrs differed between the BPD and non-BPD (-1.51 [-3.59, -0.41], -0.89 [-2.64, 0.52]). The prevalence of recent respiratory symptoms (range: 32-36%) did not differ between BPD and non-BPD children. Supplemental O2 in hospital was positively associated with worsening Xrs and FEV1 . CONCLUSION Preterm children have worse lung function than healthy controls. Only respiratory reactance differentiated between preterm children with and without BPD and was influenced by days of O2 in hospital. Pediatr Pulmonol. 2016;51:1347-1355. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Maureen Verheggen
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, GPO Box D184, Perth 6840, Australia.,University of Western Australia, School of Paediatrics and Child Health, Perth, Australia.,Telethon Kids, Perth, Australia
| | - Andrew C Wilson
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, GPO Box D184, Perth 6840, Australia.,University of Western Australia, School of Paediatrics and Child Health, Perth, Australia.,Telethon Kids, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - J Jane Pillow
- University of Western Australia, School of Anatomy, Physiology and Human Biology, Perth, Australia.,University of Western Australia, Centre for Neonatal Research and Education, Perth, Australia.,King Edward Memorial Hospital, Perth, Australia
| | - Stephen M Stick
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, GPO Box D184, Perth 6840, Australia.,University of Western Australia, School of Paediatrics and Child Health, Perth, Australia.,Telethon Kids, Perth, Australia.,Centre for Child Health University of Western Australia, Perth, Australia
| | - Graham L Hall
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, GPO Box D184, Perth 6840, Australia.,Telethon Kids, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Centre for Child Health University of Western Australia, Perth, Australia
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3
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Wurzel DF, Marchant JM, Yerkovich ST, Upham JW, Mackay IM, Masters IB, Chang AB. Prospective characterization of protracted bacterial bronchitis in children. Chest 2014; 145:1271-1278. [PMID: 24435356 PMCID: PMC7173205 DOI: 10.1378/chest.13-2442] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Prior studies on protracted bacterial bronchitis (PBB) in children have been retrospective or based on small cohorts. As PBB shares common features with other pediatric conditions, further characterization is needed to improve diagnostic accuracy among clinicians. In this study, we aim to further delineate the clinical and laboratory features of PBB in a larger cohort, with a specific focus on concurrent viral detection. METHODS Children with and without PBB (control subjects) undergoing flexible bronchoscopy were prospectively recruited. Basic immune function testing and lymphocyte subset analyses were performed. BAL specimens were processed for cellularity and microbiology. Viruses were identified using polymerase chain reaction (PCR) and bacteria were identified via culture. RESULTS The median age of the 104 children (69% male) with PBB was 19 months (interquartile range [IQR], 12-30 mo). Compared with control subjects, children with PBB were more likely to have attended childcare (OR, 8.43; 95% CI, 2.34-30.46). High rates of wheeze were present in both groups, and tracheobronchomalacia was common. Children with PBB had significantly elevated percentages of neutrophils in the lower airways compared with control subjects, and adenovirus was more likely to be detected in BAL specimens in those with PBB (OR, 6.69; 95% CI, 1.50-29.80). Median CD56 and CD16 natural killer (NK) cell levels in blood were elevated for age in children with PBB (0.7 × 109/L; IQR, 0.5-0.9 cells/L). CONCLUSIONS Children with PBB are, typically, very young boys with prolonged wet cough and parent-reported wheeze who have attended childcare. Coupled with elevated NK-cell levels, the association between adenovirus and PBB suggests a likely role of viruses in PBB pathogenesis.
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Affiliation(s)
- Danielle F Wurzel
- Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD.
| | - Julie M Marchant
- Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD
| | - Stephanie T Yerkovich
- School of Medicine, The University of Queensland, Brisbane, QLD; Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD
| | - John W Upham
- School of Medicine, The University of Queensland, Brisbane, QLD; Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD
| | - Ian M Mackay
- Queensland Paediatric, Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Sir Albert, Sakzewski Virus Research Centre, Children's Health Queensland Hospital and Health Service, The University of Queensland, Herston, QLD
| | - I Brent Masters
- Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD
| | - Anne B Chang
- Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD; Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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4
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Wurzel DF, Marchant JM, Clark JE, Masters IB, Yerkovich ST, Upham JW, Chang AB. Wet cough in children: infective and inflammatory characteristics in broncho-alveolar lavage fluid. Pediatr Pulmonol 2014; 49:561-8. [PMID: 23788413 DOI: 10.1002/ppul.22792] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/11/2013] [Indexed: 01/26/2023]
Abstract
Wet cough is a common feature of many disease processes affecting children. Our aim was to examine the relationships between cough nature, lower airway infection (bacterial, viral, and viral-bacterial) and severity of neutrophilic airway inflammation. We hypothesized that viral-bacterial co-infection of the lower airway would be associated with wet cough and heightened neutrophilic airway inflammation. We prospectively recruited 232 children undergoing elective flexible bronchoscopy. Participants were grouped using a cough nature symptom-based approach, into wet, dry or no cough groups. Broncho-alveolar lavage (BAL) and clinical data, including presence, nature, and duration of cough and key demographic factors, were collected. Children with wet cough (n = 143) were more likely to have lower airway bacterial infection (OR 2.6, P = 0.001), viral infection (OR 2.04, P = 0.045) and viral-bacterial co-infection (OR 2.65, P = 0.042) compared to those without wet cough. Wet cough was associated with heightened airway neutrophilia (median 19%) as compared to dry or no cough. Viral-bacterial co-infection was associated with the highest median %neutrophils (33.5%) compared to bacteria only, virus/es only and no infection (20%, 18%, and 6%, respectively, P < 0.0001). Children with wet cough had higher rates of lower airway infection with bacteria and viruses. Maximal neutrophilic airway inflammation was seen in those with viral-bacterial co-infection. Cough nature may be a useful indicator of infection and inflammation of the lower airways in children.
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Affiliation(s)
- Danielle F Wurzel
- Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Queensland, Australia; Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, Queensland, Australia
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Affiliation(s)
- Will D Carroll
- Nottingham University, Derbyshire Children's Hospital, Uttoxeter Road, Derby DE22 3NE, UK.
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Abstract
The principal aims of asthma management in childhood are to obtain symptom control that allows individuals to engage in unrestricted physical activities and to normalize lung function. These aims should be achieved using the fewest possible medications. Ensuring a correct diagnosis is the first priority. The mainstay of asthma management remains pharmacotherapy. Various treatment options are discussed. Asthma monitoring includes the regular assessment of asthma severity and asthma control, which then informs decisions regarding the stepping up or stepping down of therapy. Delivery systems and devices for inhaled therapy are discussed, as are the factors influencing adherence to prescribed treatment. The role of the pediatric health care provider is to establish a functional partnership with the child and their family in order to minimize the impact of asthma symptoms and exacerbations during childhood.
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Affiliation(s)
- André Schultz
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Australia
- Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Australia
| | - Andrew C. Martin
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
- Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Australia
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Kuba Y, Seddon P, Ducharme FM. Hypoallergenic formula milk versus cow's milk for prevention of wheeze and asthma in children with a family history of atopy. Hippokratia 2013. [DOI: 10.1002/14651858.cd010430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yogesh Kuba
- Blackpool Victoria Hospital; Department of Paediatrics; Whinney Heys Road Blackpool UK FY3 8NR
| | - Paul Seddon
- Royal Alexandra Children's Hospital; Easten Road Brighton East Sussex UK BN2 5BE
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Skytt N, Bønnelykke K, Bisgaard H. "To wheeze or not to wheeze": That is not the question. J Allergy Clin Immunol 2012; 130:403-7.e5. [PMID: 22766098 DOI: 10.1016/j.jaci.2012.04.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 04/18/2012] [Accepted: 04/19/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diagnosis of asthma in young children is difficult and based on clinical assessment of symptoms and results of physical examination. Respiratory wheeze has traditionally been used to define asthma in young children. OBJECTIVE We sought to compare the qualitative diagnosis of wheeze with a quantitative global assessment of significant troublesome lung symptoms during the first 3 years of life as a predictor of asthma by age 7 years. METHODS Children born to asthmatic mothers (n= 411) were followed prospectively to age 7 years. Parents were instructed to visit the research clinic during the first 3 years of life each time the child had significant troublesome lung symptoms for 3 days. At the clinic, a research physician performed a physical examination, including auscultation for wheeze and excluding differential diagnoses. We tested whether wheeze was independently associated with asthma at age 7 years after adjusting for the total number of episodes. RESULTS Three hundred thirteen children had full follow-up by age 7 years. In a multivariable analysis the total number of acute clinic visits for asthma symptom was significantly associated with later asthma (P< .0001), whereas the presence of wheeze at these visits was not (P= .5). The total number of acute clinic visits for significant troublesome lung symptoms was also significantly associated with later asthma in children who had never presented with any wheeze (P= .03). CONCLUSION A quantitative global assessment of significant troublesome lung symptoms in the first 3 years of life is a better predictor of asthma than assessment of wheeze. Doctor-diagnosed wheeze is not a prerequisite for the diagnosis of asthma, and relying on the symptom of wheeze will likely be an important cause of undertreatment.
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Affiliation(s)
- Nanna Skytt
- Copenhagen Prospective Studies on Asthma in Childhood, Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Abstract
Wheeze, a common symptom in pre-school children, is a continuous high-pitched sound, with a musical quality, emitting from the chest during expiration. A pragmatic clinical classification is episodic (viral) wheeze and multiple-trigger wheeze. Diagnostic difficulties include other conditions that give rise to noisy breathing which could be misinterpreted as wheeze. Most preschool children with wheeze do not need rigorous investigations. Primary prevention is not possible but avoidance of environmental tobacco smoke exposure should be strongly encouraged. Bronchodilators provide symptomatic relief in acute wheezy episodes but the evidence for using oral steroids is conflicting for children presenting to the Emergency Department [ED]. Parent initiated oral steroid courses cannot be recommended. High dose inhaled corticosteroids [ICS] used intermittently are effective in children with frequent episodes of moderately severe episodic (viral) wheeze or multiple-trigger wheeze, but this associated with short term effects on growth and cannot be recommended as a routine. Maintenance treatment with low to moderate continuous ICS in pure episodic (viral) wheeze is ineffective. Whilst low to moderate dose regular ICS work in multi-trigger wheeze, the medication does not modify the natural history of the condition. Even if there is a successful trial of treatment with ICS, a break in treatment should be given to see if the symptoms have resolved or continuous therapy is still required. Maintenance as well as intermittent Montelukast has a role in both episodic and multi trigger wheeze. Good multidisciplinary support and education is essential in managing this common condition.
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Affiliation(s)
- Jayesh M Bhatt
- Consultant in Respiratory Paediatrics, Nottingham University Hospitals NHS Trust (QMC campus), Nottingham, NG7 2UH.
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10
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Abstract
Although wheezing illness is at its most prevalent in infancy and early childhood, its self-limiting nature in the majority poses considerable challenges in offering a long-term prognosis and in initiating long-term prophylaxis. Many of the established treatments in adults have not been adequately assessed in children. Evidence is also emerging for a number of different wheezing syndromes, several of which do not to respond well to currently available medicines. Much research interest is being directed to underlying changes within the airway that appear to be independent of allergic mechanisms and that may lead to novel therapeutic approaches. The aim of this review is to restate and update current best-practice based on evidence, to encourage effective and safe use of asthma medication in children and to point to areas of ongoing research that are likely to influence management decisions in the near future.
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Affiliation(s)
- Peter J Helms
- Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Foresterhill, Aberdeen AB25 2ZG, Scotland, UK.
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Mohangoo AD, de Koning HJ, Hafkamp-de Groen E, van der Wouden JC, Jaddoe VWV, Moll HA, Hofman A, Mackenbach JP, de Jongste JC, Raat H. A comparison of parent-reported wheezing or shortness of breath among infants as assessed by questionnaire and physician-interview: The Generation R study. Pediatr Pulmonol 2010; 45:500-7. [PMID: 20425859 DOI: 10.1002/ppul.21208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE The prevalence of asthma symptoms among preschool children is difficult to determine with accuracy because no gold standard is available for diagnosis. The aim of this study was to compare parent-reported wheezing or shortness of breath among infants as assessed by questionnaire and physician-interview. METHODS We studied 1,202 children participating in the Generation R study. Their parents completed a written questionnaire at home when the infant was 12 months old, including items on wheezing or shortness of breath. During the regular free-of-charge youth healthcare visit at age 14 months, the physician interviewed the parents to assess the presence of wheezing or shortness of breath. RESULTS The prevalence of wheezing or shortness of breath estimated from questionnaire was significantly higher than from physician-interview (36% vs. 20%; P < 0.001): observed agreement 73% (kappa 0.36). Only 41% of questionnaire-reported symptoms were assessed through the physician-interview, while 73% of physician-interviewed symptoms were reported in the questionnaire. Compared with infants in the subgroup with agreement on the presence of wheezing or shortness of breath, the infants in the subgroups without agreement significantly less often received anti-asthma medication and significantly less often had abnormal respiratory sounds or bronchiolitis or croup, and their mothers were significantly less often working. The proportion of infants receiving anti-asthma medication was higher in interview-data compared with questionnaire-data (22.7% vs. 3.9%; P < 0.001). CONCLUSIONS Questionnaire yielded higher prevalence rates for wheezing or shortness of breath than physician-interview. Physician-reported symptoms are associated with a higher proportion of infants receiving anti-asthma medication. Parent-reported asthma symptoms should be confirmed by pediatricians whenever possible.
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Affiliation(s)
- Ashna D Mohangoo
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3000 CA, the Netherlands.
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Prognostic values of specific respiratory sounds for asthma in adolescents. Eur J Pediatr 2010; 169:39-46. [PMID: 19319569 DOI: 10.1007/s00431-009-0976-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 03/13/2009] [Indexed: 10/21/2022]
Abstract
Childhood wheezing is a common condition associated with asthma, but the term is often misapplied. The present study aimed to investigate the prognostic values of specific respiratory sounds for asthma onset in adolescence. In a prospective study, six specific respiratory sounds were evaluated for their prediction of asthma. Parents were asked for respiratory sounds of their initially asthma-free children and to describe them in specified terms. Self-reported doctor-diagnosed asthma of 1,569 children aged 5 to 14 years from Germany was assessed at baseline and at follow-up for up to 12 years later. Except for 'ronchus' (17%), reported 'gasp' and 'whimper' had the highest positive predictive values of 15% and 11%, respectively. These sounds also showed the greatest increase in asthma incidence (odds ratio = 3.18; 95%CI, 1.46-6.94 and odds ratio = 2.09; 95%CI, 1.00-4.37). It could be shown that from six respiratory sounds, 'gasp' and 'whimper' were the expressions with the best prediction for asthma onset. This study suggests that parents can sensibly distinguish between respiratory sounds and that it is important to specify breathing sounds, as not all are good predictors for asthma.
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Abstract
Exercise induced wheeze and atopic disorders predict persistent asthma
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