Recurrent & Persistent Wheezing

What is a wheeze?

Wheezing is a high-pitched, whistling sound that occurs when smaller 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.

Do I need to see my doctor whenever my child wheezes?

Sure, always. Doctors and parents would disagree in around 40% cases. Hence you might be over diagnosing a wheeze and hence over-treating or you might not be recognizing a wheeze and as a result the child may not be getting appropriate medicines

What are the causes of recurrent 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, chronic suppurative lung disease, bronchiectasis (swollen and dilated airways), tuberculosis
  • Congenital problems: Tracheo-bronchomalacia, 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 aspirations

What are the red flag signs or indicators of a possible severe 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

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.