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Management of preschool wheezing in the community

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Recurrent wheeze in preschoolers, aged 10 months to six years, is a common presentation requiring consultation with a health professional. It has a cumulative prevalence of up to 40 per cent during the first six years of life, and the prevalence of wheezing is increasing over time. Most wheezing attacks are induced by viral upper respiratory tract infections, which are common in this age group.1-3

Causes and diagnosis

The first step in managing children presenting with symptoms of wheeze is to take a focused history from the parents about the child's symptoms, and what they actually mean by 'wheeze'.

In a study of 160 parents of clinic attendees, the conceptual understanding of 'wheeze' for parents of children with reported wheeze was found to be different from the epidemiological definitions. Parental report of acute wheeze and the findings by the clinicians differed.4,5 There is even inter-observer variation among the clinicians assessing wheeze with a stethoscope.6

It is therefore important to make sure that what the family is describing is actually true wheeze, and not other less specific noises, so that a specific diagnosis is not being missed.7 A true wheeze can be described as polyphonic whistling noises audible during expiration, and sometimes in inspiration.7

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