The wheezing child: an algorithm

Abstract

Background: Wheezing is a common presentation in young children. Diagnosis and treatment of these children can be challenging, as arriving at a final diagnosis often requires a process of elimination.

Objective: This article aims to provide an algorithm for managing a young child with wheeze in the primary care setting. We will aim to address key questions of some controversy that relate to this algorithm: 1. Does the child actually have wheeze – how accurate is the parents' description? 2. Do antibiotics have a role? The emergence of protracted bacterial bronchitis (PBB) 3. Is it asthma or viral wheeze, and which children outgrow this phenomenon?

Discussion: The exact cause of wheezing can be unclear in children, particularly those under pre-school age (<6 years). An algorithmic approach based on history and response to treatment often helps to distinguish between the differential diagnoses. We present one such algorithmic approach and introduce the diagnosis of persistent bacterial bronchitis in line with current thinking from the past 10 years.