Is clinical wheezing reliable as the endpoint for bronchial challenges in preschool 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.

Airway hyper‐responsiveness to adenosine 5′‐monophosphate in preschool‐age children with asthma

“…Airway responsiveness to AMP has been shown to be more specific for asthma diagnosis both in preschool-age (21) and school-age children (22). It has even been used in some clinics as the bronchial challenge of choice in young children who were referred for a possible diagnosis of asthma with a chief complaint of unexplained cough without wheezing (23,24). In contrast to its popularity, there is very limited data about the rate of AHR to AMP in childhood asthma (21,22,25).…”

The highs and lows of wheezing: A review of the most popular adventitious lung sound

“…77 Nevertheless, subjective assessment by physicians seems to compare favourably with computerized acoustic analysis, detecting wheeze with very high sensitivity, and specificity as long as the proportional wheeze time Tw/Ttot is at least 10%. 83 The low sensitivity of wheezing as an indicator of significant airway obstruction during bronchial provocation had been recognized in adults even before PCwheeze gathered interest. 84 It appears that a greater drop in FEV1, that is, more than 35% from baseline, is often required to elicit wheeze in children, 85 and adults.…”

“…During subsequent years, this parameter was used in several studies of children, and adults, but the attraction of PCwheeze as an indicator of airway hyperreactivity has lessened somewhat since some studies showed sensitivity as low as 16% and specificity of only 43% . Nevertheless, subjective assessment by physicians seems to compare favourably with computerized acoustic analysis, detecting wheeze with very high sensitivity, and specificity as long as the proportional wheeze time Tw/Ttot is at least 10% …”

Assessment of inhaled corticosteroid treatment response in asthma using hypertonic histamine challenge‐induced cough

“…However, if spirometry is not performed, the safety of a patient must be ensured by other means, e.g. by pulseoximetry or by chest auscultation (19–22).…”