Wheezing shouldn’t be a prerequisite in diagnosis of asthma
Published Online: February 27, 2012
The diagnosis of asthma in young children is difficult relying on clinical assessment of symptoms and physical examination. The respiratory wheeze has traditionally been used to define asthma in young children.
In a study in The Journal of Allergy and Clinical Immunology (JACI), Skytt et al compared the qualitative diagnosis of wheeze with a quantitative global assessment of significant troublesome lung symptoms during the first three years of life as predictor of asthma by age seven in a birth cohort of 411 children. Parents were instructed to visit the research clinic during the first three years of life each time the child had significant troublesome lung symptoms for three days. At the clinic a research doctor performed a physical examination including auscultation for wheeze and excluding differential diagnoses such as pneumonia.
Wheeze on auscultation before age three was not a significant risk factor for asthma by age seven after adjusting for the total number of episodes, while the total number of episodes (with or without wheeze) was a highly significant independent risk factor, i.e., wheeze per se is not independently associated with asthma. This indicates that a quantitative, global assessment of the burden of recurrent asthma-like symptoms in young children is a better predictor of asthma than the traditional reliance on wheeze. Indeed, asthmatic episodes without wheeze was significantly associated to asthma later in life. This shows that wheeze should not be used as a prerequisite for the asthma diagnosis.
The authors suggest that wheeze should not be a prerequisite for the diagnosis of asthma and relying on the symptom of wheeze will likely be an important cause of under-treatment. Therefore the global burden of asthmatic symptoms should be given more emphasis in daily clinical practice and the diagnosis of asthma in young children should not be excluded on the basis of negative finding of wheeze on stethoscope.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.