WHEEZING is a musical sound that occurs during expiration due to obstruction or narrowing of the lower airways. Wheezing is common in childhood. Foreign data showed that by age 1 year, 25-30 percent of infants have episodes of wheezing, increasing to 40 percent by 3 years, and 50 percent by 6 years.
Local data mostly from Metro Manila showed lower percentage of about 20-25 percent of children having episodes of wheezing by age 1 year decreasing to 11-12 percent by age 6 years.
The onset of wheezing at birth suggests congenital anomalies of the lower airways. Infection as a cause of wheezing occurs in infants and young children. Foreign body aspiration is common in children between the ages of 1 and 4 years.
Episodes of recurrent wheezing with periods of complete resolution suggest asthma. Common triggers of asthma are viral infection, allergens (substance that induces allergy), irritants (tobacco smoke, pollution), exercise and changes in air temperature.
Asthma is a chronic disease that frequently presents with acute exacerbation, a common cause of wheezing. The wheezing is diffuse due to widespread lower airway narrowing brought about by constriction of the smooth muscles of the bronchial tubes with inflammation, edema, and increased mucous secretions.
In contrast, localized wheezing is generally due to local obstruction such as TB, tumor, or foreign body. A history of choking suggests foreign body aspiration. However, the absence of such a history does not rule out foreign body as a cause of obstruction.
Foreign bodies lodged in the airways depend on their size and contour. Large foreign bodies are typically lodged in the larynx because they have difficulty passing between the vocal cords. Smaller objects can pass between the vocal cords of the larynx down to the trachea and lodge in any of the bronchi.
Foreign bodies aspirated and retained in the airways may threaten the life of a child and produce severe lung damage. Any small object that a small child can take hold with his hands will surely find its ways to his mouth, a potential for foreign body aspiration. Parents and caregivers should be made aware of the hazards and the necessity to exclude small objects from the environment (coins, plastic objects, toys, parts of a broken toy) and hard candies, piece of bone, corn grits, nuts (peanuts, etc.) and fruit seeds from the diet of a small child. Parents and caregivers can screen the objects for appropriate size by using a tube from a toilet paper roll. Objects which can fit inside this tube are too small and are considered dangerous for foreign body aspiration in children less than 3 years of age (H. W. Schwartz: The 5-Minute Consult, 2nd edition).
Emergency Care
The child with noisy breathing needs an immediate careful evaluation in order to determine quickly the cause of this worrisome problem. This ranges from benign to severe progressive obstruction that may require emergency resuscitative measures. Without prompt intervention, complete airway obstruction will lead to respiratory arrest.
After a successful emergency resuscitation, vital functions may change quickly that the child will require frequent assessments and assistance from a physician experienced in the management of critically ill children. This need should be obtained promptly.
Traditionally, the treatment of noisy breathing is directed at the cause. Some congenital anomalies can be corrected with surgery.
A child with infection will be given the appropriate antibiotics. An anti-asthma medication is given to a child with asthma. Foreign bodies can be removed during bronchoscopy, a procedure where a small tube is inserted through the mouth and into the throat, larynx and trachea. The end of the tube has light and other gadgets which allow the doctor to see inside the airway and remove the foreign body. (PVI)
