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wheezing asthma

Approach to a Child with Wheeze

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1. Definition

  • Wheeze is a high-pitched, musical, continuous sound produced by airflow through narrowed airways, typically during expiration.
  • Indicates airway obstruction at any level (from trachea to small bronchi).

2. Initial Assessment

A. ABC Assessment

  • Airway: Ensure patency; look for obstruction (secretions, foreign body).
  • Breathing:
    • Respiratory rate, effort (retractions, nasal flaring, grunting)
    • Oxygen saturation (SpO₂)
    • Presence and distribution of wheeze
    • Work of breathing (mild / moderate / severe)
  • Circulation: Heart rate, capillary refill time, BP, color.

B. Severity Assessment

SeverityFeatures
MildSpeaking in sentences, SpO₂ > 94%, mild wheeze
ModerateBreathless, feeding difficulty, SpO₂ 90–94%
SevereCannot talk/feed, SpO₂ < 90%, exhaustion, cyanosis, silent chest

3. Focused History

AspectKey Points
Onset & CourseSudden (foreign body) vs gradual (infection/asthma)
Frequency/PatternRecurrent vs first episode
TriggersViral infection, allergen, exercise, cold air, smoke
Associated SymptomsFever, cough, coryza, vomiting, feeding difficulty
Past Medical HistoryPrevious wheezing, atopy, eczema, prematurity, GERD
Family/Social HistoryAsthma, allergies, smoking, housing
Drug historyRecent medications, response to bronchodilators

4. Physical Examination

  • General: Distress, cyanosis, growth, hydration.
  • Respiratory system:
    • Chest expansion, use of accessory muscles
    • Percussion (hyperresonant / dull)
    • Auscultation:
      • Wheeze: polyphonic (asthma/viral), monophonic (focal obstruction)
      • Air entry: symmetrical or reduced
      • Crackles: suggest infection or bronchiolitis
  • Cardiac: Murmurs (congenital lesions)
  • Other systems: Skin (eczema), ENT (allergic rhinitis), clubbing.

5. Differential Diagnosis

Age GroupCommon Causes
Infant (<1 yr)Bronchiolitis, congenital airway anomalies, aspiration, GERD
Toddler (1–5 yr)Viral-induced wheeze, foreign body aspiration, asthma
Older child (>5 yr)Asthma, allergic bronchitis, chronic suppurative lung disease

6. Investigations

(Usually guided by clinical picture; many cases diagnosed clinically)

  • Pulse oximetry – essential.
  • Chest X-ray – if first episode, focal findings, suspicion of foreign body/pneumonia.
  • Blood tests – if severe or infection suspected.
  • Allergy testing / IgE – in recurrent or atopic cases.
  • Spirometry / Peak Flow – for older cooperative children (asthma diagnosis).
  • Bronchoscopy – if persistent localized wheeze or suspicion of foreign body.

7. Management

A. Immediate Management

  • Mild/Moderate:
    • Nebulized or inhaled salbutamol (via spacer or nebulizer)
    • Oxygen if SpO₂ < 94%
    • Oral prednisolone if known asthma or recurrent wheeze
  • Severe / Life-threatening:
    • High-flow oxygen
    • Nebulized salbutamol ± ipratropium bromide
    • IV steroids (hydrocortisone)
    • IV magnesium sulfate / aminophylline / salbutamol if poor response
    • Consider PICU referral

B. Underlying Cause

  • Bronchiolitis – supportive (O₂, fluids, suction)
  • Foreign body – urgent ENT/pulmonary referral
  • Asthma – follow stepwise management (as per BTS/SIGN or GINA)

8. Long-term Management

  • Identify triggers and educate parents on avoidance.
  • Asthma education: inhaler technique, action plan.
  • Follow-up to reassess control and adjust therapy.

9. Red Flags

  • Silent chest, exhaustion, cyanosis
  • Poor air entry or asymmetry
  • Persistent localized wheeze
  • Failure to thrive or recurrent pneumonia
  • Sudden onset without infection (→ foreign body)

10. Summary Table

StepKey Action
1ABC and severity assessment
2Focused history
3Physical examination
4Consider differential diagnoses
5Targeted investigations
6Manage acutely + treat cause
7Educate and follow-up

Thyroid hormones, World Thyroid day 2023

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Tips to keep your thyroid healthy step by step

Please read through all the article to know thyroid disorders and everything else about them. Tips are at the end.

What is thyroid?

Thyroid is a endocrine gland located in central neck. This gland produces thyroid hormones names T3 and T4 (tri-iodithroxin and tetraiodothyroxine). T3 is less in amount but more active while T4 is large in amount and less actice. For T4 to act in body it first needs to be converted in T3 which is done in the tissues. Almost all of the human cells need thyroid hormones to function well.

Read about role of hormones in menstrual cycle here

World thyroid day, 25th May

Today, May 25th is the world thyroid day. It is a day celebrated internationally in a inntention to spread awareness regarding thyroid hormones, it importance and diseases realted to thyroid hormones and thyroid gland. Ths day is recognized globally by the American Thyroid Association in cooperation with the European Thyroid Association, the Asia-Oceania Thyroid Association and the Latin American Thyroid Society, to empower people with education about thyroid gland and thyroid gland related diseases.

What hormones are produced by thyroid gland?

T3 and T4 are the hormones produced by thyroid gland. Besides this Calcitonn is also produced by the thyroid gland but this is related to calcium metabolism.

For T3 and T4 to be produced in thyroid, The pituitary gland needs to secrete TSH (thyroid stimulating hormone). Check the following diagram.

How is thyroid hormones regulated?

https://www.chaitanya.com.np/2023/05/council-for-technical-education-and.html

TSH is the hormone necessary to regulate the amount of T3 and T4 secreted in body. (Check diagram) TSH is also regulated by amount of TRH (thyrotropin releasing hormone) produced by the anterior pituitary gland.

What are the 10 functions of the thyroid hormones?

Here is complete list of functions of thyroid hormones. Here, you can see that thyroid hormone is realted to all the body which signifies its importance.

  1. Brain maturation
  2. Bone and body growth
  3. Control of heart function and autonomic nervous system
  4. Maintainance of basal metabolic rate
  5. Regulation of blood sugar levels
  6. Control of lipid and cholesterol level
  7. Maturation of lungs of babies
  8. Sexual and reproductive health maintainance
  9. Prevention of infection and accelerate healing
  10. Regulation and maintainance of body nad body functions

How do you know if your thyroid is not working well?

25 features of thyroid disorder everyone must know

Here is list of few symptoms that are seen in thyroid hormones related disorders. But these symptoms may vary depending whether you have more or less thyroid production. (See picture: Hypo vs Hyperthyroidism)

  1. Irregular bowel movements
  2. Thinning of hair, hairrfall, dry hair
  3. Hairs that wont grow
  4. High cholesterol level
  5. Waking up with headache, weakness, bodyache
  6. Difficulty gaining weight or sudden losing of weight
  7. Cold or very warm hands and feet
  8. Fatigue, weakness and lack of energy thats persistent
  9. Lack of motivation, mood swings, difficulty concentrating
  10. Dry skin and scalp
  11. Insomnia
  12. Too much of sleep
  13. Palpitation
  14. Increased blood pressure
  15. Anxiety, emotional distress, psychological problems
  16. Excessive sweating, wet hands and feet
  17. Neck swelling, mass, goitre
  18. Voice changes, too sharp or bold
  19. Heat or cold intolerence
  20. Change in appetite, problem with digestion
  21. Muscle and joints ache
  22. Menstrual irregularities
  23. Recurrent infections, sexual dysfunction, infertility
  24. Vitamin D and other hormone disbalance
  25. Swelling of body, nonpitting type oedema, especially around eyes and leg

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What are the common disease of thyroid gland?

Hypothyroidism

  1. Hashimoto thyroiditis
  2. Subacute granulomatoud thyroiditis
  3. Riedel thyroiditis
  4. Congenital hypothyroidism
  5. Iodine deficinecy
  6. Iodine excess
  7. Drug induced hypothyroidism
  8. Nonthyroidal illness syndrome

Hyperthyroidism

  1. Grave disease
  2. Toxic multinodular goitre
  3. Thyroid storm
  4. Jod-Basedow phenomenon
  5. Thyroid adenoma

Thyroid cancers

  1. Thyroid adenoma (benign)
  2. THyroid cysts (benign)
  3. Papipllary carconoma
  4. Follicular carcinoma
  5. Medullary carcinoma
  6. Undifferentiated/Anaplastic carcinoma

Tips to keep your thyroid healthy

Following are the basic things that can be done to help prevent thyroid disorders:

  1. Take Magnessium
  2. Take semenium
  3. Exercise
  4. Take a healthy balanced diet
  5. Avoid gluten containing foods
  6. Get enough sleep
  7. Avoid excess sugar
  8. Take iodine supplement

Why is the MDF Stethoscope the Top Choice for Medical Professionals?

Read more at www.chaitanya.com.np

  1. American Thyroid Association | ATA: https://www.thyroid.org/
  2. British Thyroid Association: https://www.british-thyroid-association.org/
  3. Australian thyroid foundation: https://www.thyroidfoundation.org.au/
  4. Diabetes and endocrinology association of Nepal: https://www.dean.com.np/