Wheeze teaching event
Case 1:
4 year old Jonny comes to the GP’s surgery with difficulty in breathing. His parents have reported a runny nose and reduced oral intake in the last few days.
There have been two previous similar episodes with an URTI. The family has two dogs & Jonny has always been fine with them. There is no family history of asthma, atopy or smoking. His parents have reported that Jonny is fine playing in park & cold weather is not something that makes his symptoms worse. He has been very well between his last two episodes & he has not required any regular medications such asSalbutamol inhaler. There is no history of food allergy or allergic rhinitis symptoms in him.
On examination, wide spread wheezes were heard with an increased effort of breathing. On this occasion,Salbutamol inhaler via a spacer has helped (similar to previous occasions). The child has improved & inhalers were not required after he recovered from the cold.
His family would like to know what the diagnosis is so they can research further themselves.
Please discuss this case on your table and give the possible diagnosis & management plan.
Is it Episodic Viral wheeze or multi trigger wheeze? Please give your reasoning.
Case 2:
3 year old Gemma comes to the GP’ssurgery with difficulty in breathing. Her parents have reported a runny nose and reduced oral intake in the last few days.
There have been three previous similar episodes, one of which was an URTI & another with onset of cold weather.The family has no animals at home; however, her parents smoke, “but never in front of Gemma.” She has frequent night time coughing in the winter months. There is no family history of asthma or atopy. The parents have reported that Gemma does wheeze whilst playing in the park & sometimes they have used medications such asSalbutamol inhaler. She is generally well but her parents feel that the cold reaches her chestrather faster than her siblings. There is no history of food allergy or allergic rhinitis symptoms in her.
On examination, wide spread wheezes were heard with an increased effort of breathing. On this occasion,Salbutamol inhaler via a spacer has helped (similar to previous occasions). The child has improved &her parents had stopped the inhalers once she hadrecovered.
Her family would like to know what the diagnosis is so they can research itfurther themselves.
Please discuss this case on your table and give the possible diagnosis & management plan.
Is it Episodic Viral wheeze or multi trigger wheeze? Please give your reasoning.
Rahul Chodhari, RFH.