Acute Respiratory Infections Pt.3

Wheezing
 

Causes

• Under age 2 -Bronchiolitis
• Older children plus those with recurrent attacks of wheeze -bronchial asthma or reactive airways disease
• transient wheezers
• persistent wheezers
• Other respiratory infections
• Inhaled foreign body
• Tuberculous node compressing bronchus

Drug management

• Bronchodilators for asthma or recurrent airways disease but notfor bronchiolitus
• Use of metered-dose inhalers with spacer device
• Relatively inexpensive -Salbutamol inhaler $ 1.50 for 200 doses
• Can be used in outpatient setting and at home
• Combined inhaler and inhaled steroids (expensive) reserved for cases of recurrent asthma

Disadvantages of Addition

• Not a major cause of mortality
• Recognition of audible wheeze is poor with low specificity
• Incorrect diagnoses increase clinic visits and drug use
• Drugs and supplies expensive to buy and maintain at first-level facilities
• Drugs often diverted to adults

Consider Addition

• In countries that can afford bronchodilators and where morbidity from asthma is a problem
  In areas where rapid-acting bronchodilators are available at first-level facilities
  When health workers are trained to recognize audible wheeze and use bronchodilators
• If it will reduce unnecessary referral to the hospital
• If caretakers can be trained in home use/compliance
• If the health worker can recognize when a child with recurrent wheeze is not responsive in the first-level health facility
• If health workers can recognize underlying bacterial pneumonia