Wheezing children

Abstract

The wheezing child is a common clinical problem. Asthma is by far the commonest cause of wheezing, but other conditions must be considered, especially in the young child. These include respiratory tract infection, expecially viral bronchiolitis, inhalation of a foreign body, cystic fibrosis, primary tuberculosis, and congenital anomalies. Clinical and radiological examination will usually identify these conditions. The role of infection in wheezing in the young child is not clear. Acute bronchitis with airways obstruction may produce a wheeze with associated respiratory distress, fever, leucocytosis, and general malaise. If these attacks recur terms such as “wheezy bronchitis,” “asthmatic bronchitis,” and “pseudoasthma” are applied. Antibiotics are often prescribed but with doubtful benefit. Viral infection may be responsible for some attacks, but several studies have shown that viruses can be isolated from only about a third of patients and their role in the pathogenesis is uncertain. Williams and McNicol1 made a valuable contribution to our understanding of this group of young wheezing children who have apparent preceding infection. After a prospective long-term epidemiological study they concluded that they could not separate recurrent “wheezy bronchitis” from asthma. Their evidence suggests that both conditions exhibit a common basic asthmatic disorder, but the spectrum of severity varies greatly from a few mild early attacks that abate to established severe asthma persisting into adult life. © 1976, British Medical Journal Publishing Group. All rights reserved.