|Approach to wheezing in children |
|Author |Section Editor |Deputy Editor |
|Khoulood Fakhoury, MD |Gregory Redding, MD |Alison G Hoppin, MD |
Last literature review version 17.2: May 2009 | This topic last updated: February 10, 2009 (More)
INTRODUCTION — Wheezing is a common presenting symptom of respiratory disease in children. Epidemiologic studies conducted worldwide have shown that 10 to 15 percent of infants wheeze during the first year of life, and as many as 25 percent of children younger than five years of age present to their clinicians with wheezing respiratory illnesses [1-3].
Most children with recurrent wheezing are very likely to have asthma, regardless of the age of onset, evidence of atopic disease, precipitating causes, or frequency of wheezing . However, other diseases can present with wheezing in childhood, and patients with asthma may not wheeze. Therefore, the initial evaluation of a wheezing child should be directed toward the exclusion of alternative diagnoses, followed by a therapeutic trial of bronchodilators if asthma is suspected.
The differential diagnosis of wheezing includes a variety of congenital and acquired conditions (show table 1). Clinical history, physical examination, laboratory investigations, and response to treatment all play a role in establishing the underlying etiology of wheezing .
A diagnostic approach to wheezing in childhood is presented here. An overview of the diagnosis and management of asthma and a review of the causes of nonasthmatic wheezing in children are presented separately. The emergent evaluation of...