Recurrent & Persistent Wheezing

What is a wheeze?
Wheezing is a whistling sound that occurs when airways are narrowed by edema, bronchospasm, secretions etc. Can I hear a wheeze myself?

  • Sometimes wheezing sounds can be audible and you may hear them.
  • Many a times you may not be able to appreciate these sounds and your doctor can hear with a stethoscope.

What are the causes of recurrent episodes of wheezing in children?
The most common causes are asthma in an older child and wheezing related viral respiratory tract infections in a younger child

There can be other not so common causes like:

  • Infections : bacterial bronchitis, bronchiectasis (swollen and dilated airways), tuberculosis
  • Congenital (since birth) problems : Tracheo-bronchomalacia (weakness of the airway wall), cystic fibrosis, primary ciliary dyskinesia, Immune deficiency, compression or the windpipe due to a blood vessel or a lymph node, H type Tracheo-esophageal fistula (abnormal communication between the windpipe and feeding pipe)
  • Mechanical Problems like gastroesophageal reflux and foreign body in the airway

What are the red flag signs or indicators of a possible serious cause of wheeze?

  • Failure to thrive or not gaining weight
  • Presence of persistent cough with phlegm
  • Wheezing persisting for more than 4 weeks
  • Stridor/noisy breathing
  • Age of onset less than 6 months
  • Severe wheeze episodes requiring hospital admissions

How do we evaluate a child with recurrent or persistent wheezing?

  • Initially we would take a detailed history and examine the child. This would be followed by review of all old records and chest xrays if any.
  • Initial investigations would include a chest x-ray and a spirometry (breathing test) for a older child.
  • Some children might need further investigations to identify the cause of wheezing like a flexible bronchoscopy, CT scan of chest, investigations for Gastro-esophageal reflux, etc.

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