Why do Infants Wheeze

Question 1

Wheeze

Answer 1

From oscillations in narrowed airways
Frequency depends on degree of narrowing, elasticity of airway wall and local airflow
Inspiratory or expiratory
High or low pitched

Question 2

Expiratory wheeze

Answer 2

From chest
Bronchi affected
High pitch?

Question 3

Inspiratory wheeze

Answer 3

From throat

Trachea

Question 4

Preschool wheeze

Answer 4

Usually triggered by colds

Question 5

Preschool RFs

Answer 5

Younger mother
Smoking in pregnancy
Postnatal smoke exposure
Male
Premature birth
Air pollution

Question 6

Transient early wheezers

Answer 6

Peak 0-3 years
Born with lung infection + tendency to develop hyper-reactive airways with colds
Stop wheezing by age 3
Normal lung function by age 11

Question 7

Non-atopic wheezers

Answer 7

Peak 3-6 years
Symptomatic LRT Viral infection (RSV bronchiolitis) in early life
Continue to wheeze beyond 3rd year
Most outgrow condition

Question 8

Ig-E associated wheeze/asthma

Answer 8

Increases >6 years
Wheeze between colds
Wheeze attacks triggered by colds
Persistent inflammation throughout central and peripheral airways
Denudation of airway epithelium
Infiltration of lymphocytes and eosinophils

Question 9

Asthmatic cellular levels

Answer 9

Goblet cell hyperplasia
Thick sub-basement membrane
Cellular infiltrate

Question 10

Wheeze treatment

Answer 10

Inhaled short-acting beta-2 agonists
Inhaled steroid or LTRA if steroid can’t be used
LTRA- leukotriene receptor antagonist
Refer to resp. paediatrician

Question 11

Bronchogenic cysts

Answer 11

Thin-walled with ciliated columnar lining
May contain cartilage, smooth muscle
Some have gastro-oesophageal mucosa
Air of fluid filled
Presents- early with resp. distress, later with infection, asymptomatic
Treatment- surgical removal

Question 12

Congenital lobar emphysema

Answer 12

Over distension of lobe
Partial bronchial obstruction
Ball valve effect