Wheezing illnesses other than asthma in children
- Khoulood Fakhoury, MD
Khoulood Fakhoury, MD
- Assistant Professor of Pediatrics
- Baylor College of Medicine
Wheezing is a common presenting symptom of respiratory disease in children. A nationwide survey in the United States between 1988 and 1994 showed that the prevalence for wheezing amongst two to three year olds was 26 percent and amongst 9 to 11 year olds was 13 percent . A wide range of prevalence of wheeze is observed between and within countries over time. Between 1994 to 1996, for example, the United Kingdom had the highest recorded prevalence of wheezing (31 percent) and Ethiopia the lowest (1.7 percent) .
Wheezing can be divided clinically according to the acuity of its onset and the mechanism of airway narrowing. In addition to asthma, new-onset acute wheezing suggests infection or sudden airway obstruction, whereas chronic or recurrent wheezing may be caused by congenital abnormalities, cardiac disease, aspiration syndromes, impaired immunologic defenses, or underlying pulmonary disease.
One in three children experience at least one acute wheezing illness before the age of three years [3,4]. Most infants and young children with recurrent wheezing probably have asthma. However, a wide variety of congenital and acquired conditions can cause narrowing of the extrathoracic or intrathoracic airways and may present with wheezing (table 1). An overview of the causes of nonasthmatic wheezing in children is presented in this topic review.
A diagnostic approach to wheezing, including the definition and physiology of wheezing, and an overview of the diagnosis and management of asthma are presented separately. The emergent evaluation of children with acute respiratory distress is also discussed separately. (See "Approach to wheezing in infants and children" and "Asthma in children younger than 12 years: Initial evaluation and diagnosis" and "An overview of asthma management" and "Acute respiratory distress in children: Emergency evaluation and initial stabilization".)
In addition to asthma, acute onset of wheezing in a child is most often caused by an infectious process or foreign body aspiration (FBA).
- Eldeirawi K, Persky VW. History of ear infections and prevalence of asthma in a national sample of children aged 2 to 11 years: the Third National Health and Nutrition Examination Survey, 1988 to 1994. Chest 2004; 125:1685.
- Patel SP, Järvelin MR, Little MP. Systematic review of worldwide variations of the prevalence of wheezing symptoms in children. Environ Health 2008; 7:57.
- Taussig LM, Wright AL, Holberg CJ, et al. Tucson Children's Respiratory Study: 1980 to present. J Allergy Clin Immunol 2003; 111:661.
- Bloomberg GR. Recurrent wheezing illness in preschool-aged children: assessment and management in primary care practice. Postgrad Med 2009; 121:48.
- Finder JD. Understanding airway disease in infants. Curr Probl Pediatr 1999; 29:65.
- McLaren CA, Elliott MJ, Roebuck DJ. Vascular compression of the airway in children. Paediatr Respir Rev 2008; 9:85.
- Moss AJ, McDonald LV. Cardiac disease in the wheezing child. Chest 1977; 71:187.
- Rabinovitch M, Grady S, David I, et al. Compression of intrapulmonary bronchi by abnormally branching pulmonary arteries associated with absent pulmonary valves. Am J Cardiol 1982; 50:804.
- Lee SL, Cheung YF, Leung MP, et al. Airway obstruction in children with congenital heart disease: assessment by flexible bronchoscopy. Pediatr Pulmonol 2002; 34:304.
- Martinati LC, Boner AL. Clinical diagnosis of wheezing in early childhood. Allergy 1995; 50:701.
- Tsubata S, Ichida F, Miyazaki A, et al. Bronchial hyper-responsiveness to inhaled histamine in children with congenital heart disease. Acta Paediatr Jpn 1995; 37:336.
- Pisanti A, Vitiello R. Wheezing as the sole clinical manifestation of cor triatriatum. Pediatr Pulmonol 2000; 30:346.
- Reisman JJ, Canny GJ, Levison H. Wheezing in infants and young children. In: Childhood asthma-pathophysiology and treatment, 2nd ed, Tinkelman DG, Naspitz CK (Eds), Marcel Dekker, New York 1993. p.225.
- Ferreira SM, Ferreira AG Jr, Meguins LC, Neto DB. Asthma as a clinical presentation of cor triatriatum sinister in a Brazilian Amazon child: a case report. J Cardiovasc Med (Hagerstown) 2009; 10:795.
- Turner A, Gavel G, Coutts J. Vascular rings--presentation, investigation and outcome. Eur J Pediatr 2005; 164:266.
- Bakker DA, Berger RM, Witsenburg M, Bogers AJ. Vascular rings: a rare cause of common respiratory symptoms. Acta Paediatr 1999; 88:947.
- Ruzmetov M, Vijay P, Rodefeld MD, et al. Follow-up of surgical correction of aortic arch anomalies causing tracheoesophageal compression: a 38-year single institution experience. J Pediatr Surg 2009; 44:1328.
- Celedón JC, Litonjua AA, Ryan L, et al. Bottle feeding in the bed or crib before sleep time and wheezing in early childhood. Pediatrics 2002; 110:e77.
- Maturo S, Hill C, Bunting G, et al. Pediatric paradoxical vocal-fold motion: presentation and natural history. Pediatrics 2011; 128:e1443.
- Patterson R, Schatz M, Horton M. Munchausen's stridor: non-organic laryngeal obstruction. Clin Allergy 1974; 4:307.
- Moonnumakal SP, Fan LL. Bronchiolitis obliterans in children. Curr Opin Pediatr 2008; 20:272.
- Fischer GB, Sarria EE, Mattiello R, et al. Post infectious bronchiolitis obliterans in children. Paediatr Respir Rev 2010; 11:233.
- Park M, Koh KN, Kim BE, et al. Clinical features of late onset non-infectious pulmonary complications following pediatric allogeneic hematopoietic stem cell transplantation. Clin Transplant 2011; 25:E168.
- Nishio N, Yagasaki H, Takahashi Y, et al. Late-onset non-infectious pulmonary complications following allogeneic hematopoietic stem cell transplantation in children. Bone Marrow Transplant 2009; 44:303.
- Sweet SC. Pediatric lung transplantation. Proc Am Thorac Soc 2009; 6:122.
- Colom AJ, Teper AM. Clinical prediction rule to diagnose post-infectious bronchiolitis obliterans in children. Pediatr Pulmonol 2009; 44:1065.
- Gunn ML, Godwin JD, Kanne JP, et al. High-resolution CT findings of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. J Thorac Imaging 2008; 23:244.
- Yamane M, Sano Y, Toyooka S, et al. Living-donor lobar lung transplantation for pulmonary complications after hematopoietic stem cell transplantation. Transplantation 2008; 86:1767.
- Müller C, Görler H, Ballmann M, et al. Pulmonary retransplantation in paediatric patients: a justified therapeutic option? A single-centre experience. Eur J Cardiothorac Surg 2011; 39:201.
- ACUTE WHEEZING
- Foreign body aspiration
- CHRONIC OR RECURRENT WHEEZING
- Structural causes
- - Anomalies of the tracheobronchial tree
- - Cardiovascular disease
- - Mediastinal masses
- Functional causes
- - Aspiration syndromes
- - Host defense abnormalities
- - Cystic fibrosis
- - Bronchopulmonary dysplasia
- - Paradoxical vocal cord motion
- - Bronchiolitis obliterans
- - Interstitial lung disease