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Early diagnosis effects the prognosis in children with atypical wheeze
Ezgi Ulusoy Severcan1, Esen Demir1, Figen Gülen1
1Division of Pediatric Allergy and Immunology, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey.
Insights
Prompt evaluation of atypical wheezing in children is crucial. Early diagnosis and treatment of underlying conditions like bronchopulmonary dysplasia significantly improve outcomes, with early presentation leading to better regression rates.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Recurrent wheezing is a common pediatric respiratory issue.
- Wheezing in children is often categorized into typical and atypical presentations.
- Identifying features of atypical wheezing is essential for accurate diagnosis.
Purpose of the Study:
- To characterize the general features of preschool children with atypical recurrent wheezing.
- To identify underlying diseases associated with atypical wheezing in this population.
- To understand the diagnostic distribution and clinical course of atypical wheezing.
Main Methods:
- Retrospective analysis of 302 children with ≥3 wheezing attacks between 2000-2015.
- Inclusion criteria: diagnosed underlying diseases (e.g., bronchiectasis, cystic fibrosis, foreign body aspiration).
- Evaluation included clinical data, radiology (high-resolution lung tomography), and pulmonary function tests.
Main Results:
- Bronchopulmonary dysplasia was the most common diagnosis (21.9%).
- High-resolution lung tomography revealed distinct findings like mosaic oligemia and bronchiectasis.
- Early hospital presentation (0-6 months) correlated with better regression (63.4%) compared to late presentation (>5 years, 7.5%).
Conclusions:
- Prompt evaluation for underlying conditions in recurrently wheezy children is vital.
- Early diagnosis and timely treatment are critical for improving patient prognosis.
- Atypical wheezing presentations necessitate thorough investigation to guide management.
Aim:
Recurrent wheezing is a common problem in preschool children.It is classified into two groups because there can be many reasons for wheeze: typical and atypical. The aim of this study was to identify the general features of atypical wheezy children.
Material And Methods:
Three hundred two children who presented to our clinic between 2000 and 2015 for three or more wheezing attacks and were diagnosed as having an underlying disease such as bronchiectasis, foreign body aspiration, recurrent aspiration pneumonia, cystic fibrosis, bronchopulmonary dysplasia, congenital anomalies, and tuberculosis, were included in the study.
Results:
In this study, 127 (42.1%) girls and 175 (57.9%) boys were evaluated. The diagnostic distribution of the patients was as follows: bronchopulmonary dysplasia (21.9%), bronchiolitis obliterans (16.6%), bronchiectasis (14.5%), bronchiolitis obliterans + primary immunodeficiency (12.3%), cystic fibrosis (10.3%), bronchiectasis + primary immunodeficiency (7.9%), recurrent aspiration pneumonia (3.6%) and foreign body aspiration (3.3%), and other diseases (9.6%). Mosaic oligemia, bronchiectasis, atelectasis, bronchiolectasis, and small airway disease were the most distinct findings on high-resolution lung tomography. When the patients were evaluated clinically, radiologically, and according to pulmonary functions after an average period of 40 months, it was seen that 9.2% deteriorated, 33.9% regressed, and 56.7% remained stable. Presentation to hospital after the first attack occurred earlier in patients with bronchopulmonary dysplasia, bronchiolitis obliterans and bronchiolitis obliterans + primary immunodeficiency compared with patients with bronchiectasis, bronchiectasis + primary immunodeficiency, and cystic fibrosis. When presentation time and outcomes were evaluated, it was found that 63.4% of patients who presented to hospital early (0-6 months) and 7.5% of patients who presented late (after 5 years) had regression.
Conclusion:
Recurrent wheezy children must be promptly evaluated for an underlying disease. Early diagnosis and treatment influence the prognosis.
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