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.