Official American Thoracic Society Clinical Practice Guidelines: Diagnostic Evaluation of Infants with Recurrent or Persistent Wheezing

Abstract

Although infantile wheezing is common, there is a paucity of evidence to guide clinicians in selecting diagnostic tests for recurrent or persistent wheezing. Our committee made several conditional recommendations to guide clinicians; however, additional research that measures clinical outcomes is needed to improve our confidence in the effects of various diagnostic interventions and to allow advice to be provided with greater confidence.

Pediatric pulmonology year in review 2017: Part 1

“…This study shows that a bronchoscopic evaluation is worthwhile in children with the clinical characteristics described and will yield a high proportion of clinically meaningful information. This finding is consistent with recent American Thoracic Society clinical guidelines for evaluation of wheezing infants …”

“…This finding is consistent with recent American Thoracic Society clinical guidelines for evaluation of wheezing infants. 7 A large international study of the practice and availability of…”

Pilot study shows right ventricular diastolic function impairment in young children with obstructive respiratory disease

“…Cardiovascular impairment is a common co‐morbidity in patients with chronic airway obstruction . The link between cardiac function and obstructive respiratory diseases has been investigated but, to date, the incidence of cardiac complications and the extent of pulmonary lung damage have been underestimated.…”

“…However, reliable lung function testing in children under six years of age is difficult, due to the limited degree of cooperation and coordination expected at this age (8)(9)(10). If children have trouble cooperating, the opening interrupter technique (RINT) is a quick and easy way to obtain indirect measurements of airway resistance without any effort from the patient (11,12). Several studies have demonstrated that RINT is effective at diagnosing the presence of airway Abbreviations PASP, Pulmonary artery systolic pressure; RINT, Opening interrupter technique; TAPSE, Tricuspid annular plane systolic excursion; TFPV, Tricuspid flow propagation velocity.…”

Trans‐nasal flexible bronchoscopy in wheezing children: Diagnostic yield, impact on therapy, and prevalence of laryngeal cleft

“…Many children evaluated for wheezing are too young to perform pulmonary function testing that might otherwise identify the cause of their symptoms. In children with persistent, frequently recurring, or atypical wheezing, flexible bronchoscopy (FB) is recommended to evaluate the cause of their wheezing …”