Pediatric emergency medicine trisk 1655 1655
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battery of questions may include the following: (i) How acutely did the symptoms
present? (ii) Was the patient choking or did he or she become cyanotic? (iii) Has
this occurred before? (iv) Are there concurrent upper respiratory symptoms? (v)
Does the patient have a history of cardiac disease or failure to thrive? (vi) Does
anyone in the family have asthma? Table 84.3 reviews salient features of
common disorders that cause wheezing.
The onset of wheezing in the neonatal period is associated with congenital
structural airway anomalies, although a history of prematurity, mechanical
ventilation, and oxygen dependence is more suggestive of CLD. The first episode
of wheezing in an otherwise healthy infant in association with respiratory
symptoms suggests bronchiolitis, especially if the episode occurs in the winter
months. Recurrent episodes of wheezing precipitated by respiratory infections
and a variety of other triggers are the hallmark of asthma. However, recurrent
wheezing beginning in infancy, or “difficult-to-control asthma” at any age, should
lead to a consideration of other less common diagnoses, such as CF, GE reflux,
recurrent pulmonary aspiration, a retained airway foreign body, and immune
deficiency. Persistent wheezing at any age suggests mechanical airway
obstruction from a variety of causes, including congenital airway narrowing,
pulmonary foreign body, and compression by a mediastinal tumor. Sudden onset
of wheezing is characteristic of pulmonary aspiration or anaphylaxis.
