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Video clips of infants with a variety of breathing noises led to 30Vo of respondents using other
words to describe wheezing and30Vo using the term 'wheeze' incorrectly @lphick, Sherlock
et al. 2001).
In addition, all that wheezes is not asthma (see Table 1.1). Up to 40Eo of infants who have
been hospitalised with bronchiolitis may have subsequent wheezing episodes, usually in
association with viral infections, up to five years of age (Martinez, Wright et al. 1995) and
approximately LUVo continue to wheeze after age five years (Noble, Murray et al. 1997;
Sigurs, Bjarnason et al. 2000; Hall 2001). In the Tucson study of over 1200 children, wheeze
was reported in almost 50Vo at some time between birth and six years (Martinez, Wright et al.
1995). Similar studies from Europe suggest l5-327o of children had wheezing in the first five
years of life (Strachan 1985; Park, Golding et al. 1986). Sixty to 80Vo of infants who start
wheezing in their first two years of life do not go on to have asthma. This group is found to
have diminished airway function present prior to the onset of wheeze, and wheeze often
ceases around the age of 3-5 years (Morgan and Martinez L992; Holberg, Wright et al. 1993;
Wilson 1994; Martinez, Wright et al. 1995; Clough, Keeping et al. 1999) which confirms the
findings of a much earlier study @oesen 1953). However, a minority of wheezy infants will
develop later asthma (Wilson 1994; Martinez, Wright et al. 1995; Cochran 1998). These
children continued to have wheezy episodes, developed an increased total serum
immunoglobulin E (IgE) bV age 9 months, developed sensitivity to a panel of aeroallergens by
age 6 years, and had significantly lower lung function by age 6 years (Martinez 2002).In
prospective follow up studies from childhood to adolescence, up to 80Vo of asthmatic children
were reported to lose their symptoms during puberty (Balfour-Lynn 1985; Peat, Salome et al.
1989; Nicolai, Illi et al. 1998). Thus asthma may then remit in later childhood or may
continue throughout childhood and into adult life (von Mutius 2001; Weinberger 200.3).
Table 1.1: Alternative diagnoses in children with wheeze
Angio-oedemia
Aspiration
syndromes
including foreign bodies Ainray compression bronchogenic or pulmonary
cyst, lymph nodes, tumour
(carcinoid, lymphoma),
vascular ring or sling
q1-antiprotease
deficiency
(older child)
Bacterial tracheitis respiratory syncytial virus,
metapneumovirus,
parainfluenza, influenza,
adenovirus
Anaphylactic
reactions
Angioedema
Bronchiolitis Aspiration including foreign bodies