58. Wheeze

Question 1

Differentials.

a) Children (resp, non-resp, congenital)
b) Adults

Answer 1

a) - Resp: LRTI, transient wheezing in infancy/ viral wheeze (disappears by age 3), asthma, bronchiolitis, croup (more likely stridor), cigarette smoke, foreign body inhalation, bronchiectasis
- Non-resp: GORD, heart failure
- Congenital: CF, congenital heart disease, tracheo-oesophageal fistula, bronchopulmonary dysplasia, immunodeficiency, vascular rings, tracheo-bronchomalacia and primary ciliary dyskinesia

b) - Resp: COPD, asthma, malignancy, bronchiectasis, CF,
- Non-resp: GORD, CCF

Question 2

Examination.

- possible signs on examination

Answer 2

a) Clubbing - CF, congenital heart disease, chronic lung infection
- Allergic rhinitis, urticaria and eczema suggest asthma (or an allergic reaction in a child with eczema).
- Nasal polyps - allergies, cystic fibrosis

Question 3

Management

Answer 3

• Bronchodilator therapy
• Prednisolone
• Treat underlying cause