Reported versus confirmed wheeze and lung function in early life

Abstract

Aims: To investigate the relation between parentally reported wheeze (unconfirmed), physician confirmed wheeze, and subsequent lung function. Methods: Children at risk of allergic disease (one parent atopic) were recruited antenatally and followed prospectively from birth. During the first three years of life parents were asked to contact the study team if their child was wheezy. The presence of wheeze was confirmed or not by the primary care or study physician. Respiratory questionnaire and specific airway resistance measurement (sR aw , body plethysmograph) were completed at age 3 years. Results: A total of 454 children were followed from birth to 3 years of age. One hundred and eighty six (40.9%) of the parents reported their child wheezing in the first three years of life, and in 130 (28.6%) the wheeze was confirmed. A total of 428 children attended the three year clinic review, of whom 274 (64%) successfully carried out lung function tests. There was no significant difference in sR aw (kPa?s; geometric mean, 95% CI) between children who had never wheezed (n = 152; 1.03, 1

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

“…Accurately identifying wheeze from the history can be difficult since the term is used by parents and healthcare workers to describe a variety of symptoms [15,[17][18][19]. Children with doctor-confirmed wheeze exhibit greater airways resistance than children with only reported wheeze [47], even though interobserver agreement between doctors is poor [48]. A video questionnaire may help parents to distinguish wheeze from upper airway noises [49].…”

Maybe there is no such thing as bronchiolitis

“…Parents, however, are poor at recognizing wheezing in their own children 9,10 and will often confuse wheezing with multiple other respiratory sounds. 11 Unfortunately, even physicians can be inconsistent at recognizing wheezing. 12 The profound consequence is that up to 80% 13 of infants who present to the emergency department with signs and symptoms consistent with bronchiolitis as defined by the CPS or AAP guidelines will be excluded from RCTs on bronchiolitis solely because of a history of wheezing as determined by questionable parental and physician recognition and recall of a highly variable clinical sign.…”

Classification and pharmacological treatment of preschool wheezing: changes since 2008

“…Approximately one in three children has at least one episode of wheeze before their third birthday [1,2]. Parents vary considerably in their understanding of the term ''wheeze'' [3] but wheeze confirmed by a doctor is associated with lower airway obstruction [4]. Even among such children with doctor-confirmed wheeze, considerable clinical heterogeneity exists (table 1).…”