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Is clinical wheezing reliable as the endpoint for bronchial challenges in preschool children?
Simon Godfrey1, Kamal Uwyyed, Chaim Springer
1Institute of Pulmonology, Hadassah University Hospital and Hebrew University-Hadassah Medical School, Jerusalem, Israel. sgodfrey@netvision.net.il
Insights
Clinical auscultation of wheeze in preschool children closely matches objective acoustic measurements during bronchial challenges. This study validates a reliable method for diagnosing asthma in young children.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Diagnostic Technology
Background:
- Wheezing is a common clinical sign in preschool children, often associated with asthma.
- Accurate diagnosis of asthma in young children can be challenging.
- Objective methods are needed to complement clinical assessment of wheeze.
Purpose of the Study:
- To compare clinical auscultation of wheeze with acoustic analysis during bronchial challenges in preschool children.
- To evaluate the diagnostic accuracy of acoustic wheeze detection.
- To validate objective assessment of bronchial challenge endpoints.
Main Methods:
- A prospective study involving 51 preschool children undergoing tidal breathing bronchial challenges.
- Simultaneous auscultation using an electronic stethoscope and acoustic sonogram recording.
- Manual analysis of acoustic recordings for wheeze presence, duration, and power spectrum.
Main Results:
- Clinical wheezing was detected in 22 of 24 positive bronchial challenges.
- Acoustic analysis identified wheezing in positive challenges (mean wheeze rate 28.1%), with no wheeze in negative challenges.
- Acoustic wheeze detection with a 10% cutoff demonstrated 100% sensitivity and 91% specificity compared to clinical findings.
Conclusions:
- Clinical auscultation of wheeze in preschool children aligns well with objective acoustic measurements.
- Acoustic analysis provides a reliable, objective method for detecting wheeze post-bronchial challenge.
- This approach enhances the diagnostic accuracy of asthma investigation in young children.
Abstract:
The present study was designed to compare the clinical finding of wheeze by auscultation with an objective evaluation by acoustic means at the endpoint of a bronchial challenge in preschool children. Challenges were undertaken using a tidal breathing method in 51 preschool children as part of the investigation of possible asthma. An electronic stethoscope was used for auscultation of each lung and for the simultaneous recording of the acoustic sonogram for analysis. In 24 children, the pediatrician determined that the challenge was positive, and in 22 of these, he heard wheezing at the endpoint of the challenge. In 2 children the challenge was considered positive, based on a modest fall in saturation. The acoustic record was scanned manually for presence of wheeze defined in terms of duration, and power spectrum without reference to auscultatory findings. In positive challenges, the mean wheeze rate was 28.1% (95% CI, 19.5-36.8%), while no wheeze was detected acoustically in negative challenges. Using a cutoff wheeze rate (duration of wheeze/duration of breath phase x100) of 10% for the whole group, clinical wheezing detected by the pediatrician had a sensitivity of 100% (no false negatives) and a specificity of 91%. In conclusion, the clinical observation of wheeze agrees very well with its detection by acoustic measurement at the endpoint of a bronchial challenge in preschool children.
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