A young child with a history of wheeze²

Wheezing in children under 3 years of age is common. By 30 months, 26% of children in a UK birth cohort (ALSPAC, Avon longitudinal study of parents and children) developed wheezing in the previous 12 months. Data from the latest British Thoracic Society national pediatric audit of wheezing/asthma showed that 24% of all the children admitted to hospital were between 12 and 24 months, boys outnumbering girls in a ratio of nearly 2 to 1. Early onset of wheezing is associated with lower lung function at adolescence and the presentence of atopy is associated with persisting asthma. For some children, early wheezing will translate into long-term asthma, particularly for those with early rhinovirus infections, with sensitisation to aeroallergens and with reduced lung function.

Infant wheeze, comorbidities and school age asthma³

Many young children wheeze during viral respiratory infections, but there is limited knowledge in which of these infant wheezers will develop asthma in school age. This study aims to identify clinical risk factors for asthma in children aged eight, that wheezed during infancy in a population-based setting. 

Wheeze detection: recordings vs. assessment of physician and parents⁴

It has been shown that the agreement between parental and professional as to the presence of wheezing in infants and preschool children is poor. This study compared the assessment of a parent, nurse, and physician with the “gold standard” of acoustic analysis for the presence of wheezing in infants and preschool children attending a hospital clinic. In only 10 of 31 (32%) children did the parent and the physician agree on the wheeze severity score. In 13 infants, the parent scored higher than the physician and in 8 the parent scored lower. In 24 of the 31 children (77%) the acoustic wheeze score agreed with the physician wheeze score.

What do parents of wheezy children understand by “wheeze”?⁵

Reported wheeze is one of the cornerstones of asthma diagnosis. Epidemiology studies done in the UK report increasing prevalence of childhood wheezing illness and underdiagnosis and undertreatment of asthma. Therefore, wheeze is considered important for diagnosing asthma and measure asthma prevalence. However, finding the real prevalence of wheezing is problematic; perceptions of wheeze oftentimes differ among patients, parents, and healthcare professionals. 55% of parents identified wheeze differently than clinicians.

The impact of a digital wheeze detector on parental disease management of pre-school children suffering from wheezing – a pilot study⁶

Proper treatment of viral airway infections and wheezing in children at pre-school age requires acceptable recognition of airway obstruction. As mentioned in other articles, caretakers are often struggling with this judgement, which consequently leads to insufficient or late treatment and unnecessary discomfort of the patient. Digital technologies may support parental decision taking. Within this pilot study parents were asked to use a digital wheeze detector (WheezeScan, Omron Healthcare), 2x/day for 30 days and record the child’s respiratory symptoms, detection of wheezing, and medication intake via an electronic diary (eDiary) app. Results show that parents detected wheezing without digital support in only 22/708 (3.1%) of the recorded events. By contrast, the wheeze detector indicated an airway obstruction in 140/708 (19.8%) of the recordings. The positive outcomes highlight that the WheezeScan may empower parents by increasing their capability of wheeze detection.

Acute asthma, prognosis, and treatment⁷

Patients with acute asthma will exhibit increasing shortness of breath, chest tightness, coughing, and/or wheezing. Audible wheezing is usually a sign of moderate asthma, whereas no wheezing can be a sign of severe airflow obstruction. This article is a structured review of the available literature regarding the diagnosis and management of acute asthma.

This study fits well with comments made by Dr. R. Russell in his opinion paper about how an early and accurate identification of Wheeze can improve quality of life. Contributing to the importance of detecting wheeze in disease monitoring he states: “To wait until someone complains of breathlessness takes time. If you could detect that wheeze one or two days earlier, you can intervene and stop it developing into an asthma attack”.⁸

Patient reported outcomes for preschool children with recurrent wheeze⁹

UK emergency departments are regularly attended by children with preschool wheeze. Toddlers with wheezing disorders count for 1/3rd of the presentations of respiratory disorders in this age group, and is associated with increased healthcare costs, loss of time of work in parents and impaired quality of life. A study looking at exacerbation rates between 2007-2015 in general asthma population showed that the group of children under 5 years old had the most frequent exacerbations. Since there is no international consensus regarding a specific personalised management approach, this paper attempt to co-design patient-centred outcomes with families. Concluding that by systematically using Patient-Reported Outcome Measures, the communication and decision making by doctors and patients will become better, furthermore improving patient satisfaction and outcomes of care.

Parental understanding of wheeze and its impact on asthma prevalence estimates¹⁰

In a questionnaire survey of a random population sample of 4,236 children aged 6-10 years, parent’s definition of wheeze was assessed. Current wheeze was reported by 13.2% of children, and 83.5% of parents correctly identified “whistling or squeaking” as the definition of wheeze. Frequent attacks of reported wheeze (adjusted odds ratio (OR) 3.0), maternal history of asthma (OR 1.5) and maternal education (OR 1.5) were significantly associated with a correct answer, while the opposite was found for first language not English (OR 0.6) and living in a deprived neighbourhood (OR 0.6). This study shows how misunderstanding could lead to underestimation within deprived family backgrounds.

Proximity to Major Roads and Risks of Childhood Recurrent Wheeze and Asthma in a Severe Bronchiolitis Cohort¹¹

A suggested risk factor for childhood respiratory diseases is air pollution exposure. This study investigated proximity to major roads, as an indicator for air pollution exposure, and its associations with childhood recurrent wheeze and asthma. Outcomes were parents-reported recurrent wheeze by age 3 and asthma by age 5. This study confirms that participants who resided close to a major road had the highest risk of recurrent wheeze and asthma, compared to those residing >300 m from a major road.

Associations of wheezing phenotypes with late asthma outcomes in the Avon Longitudinal Study of Parents and Children: A population-based birth cohort¹²

The aim of this study was the define extended wheezing phenotypes, this by using repeat measurements of wheeze made regularly during the first 16 ½ years of life. Another part of this study was to investigate associations of these phenotypes with physician-diagnosed asthma, lung function and FENO measures at age 14 to 15 years. After this study six wheezing phenotypes were identified: never/infrequent, preschool-onset remitting, midchildhood-onset remitting, school age-onset persisting, late childhood-onset persisting, and continuous wheeze.

Prevalence estimates and risk factors for early childhood wheeze across Europe: the EuroPrevall birth cohort¹³

Genetic factors play an important role in the cause of preschool wheeze and asthma. However, the International Study of Asthma and Allergies in Childhood, as well as the European Community Health Respiratory Survey, recognizes how environmental factors are predominantly responsible for geographic variations in the prevalence of asthma. This study determined the prevalence of wheeze in the first 2 years of life across Europe, demonstrating that it varies considerably across the north-western to south-eastern gradient. Lower respiratory trait infections, day care attendance, postnatal smoke exposure and male gender are important risk factors.

Wheezing

Wheezing is a continuous musical sound, high-pitched, during breath exhalation due to abnormal narrowed or compressed airways.¹

Almost 50% of children experiences wheeze in their first 6 years of life.¹

Early onset of wheezing is associated with lower lung function at adolescence and the presence of atopy is associated with persisting asthma.²

Perceptions of wheeze can differ among people, resulting in 55% of the parents identifying wheeze differently than clinicians.⁵

Results of a study show that parents detected wheezing without digital support in only 22/708 (3.1%) of the recorded events. By contrast, the wheeze detector (WheezeScan) indicated an airway obstruction in 140/708 (19.8%) of the recordings.⁶

The importance of detecting wheeze in disease monitoring: an early and accurate identification of wheeze can improve quality of life.⁸

Six wheezing phenotypes are identified: never/infrequent, preschool-onset remitting, midchildhood-onset remitting, school age-onset persisting, late childhood-onset persisting, and continuous wheeze.¹²