Avaliação da sibilância em lactentes e crianças

Abstract

Introduction: Wheezing is a common presenting symptom of respiratory disease in babies and children. One in three children experiences at least one acute wheezing illness before the age of three [ 1,2 ]. Wheezing can be a benign, self-limited process or the presenting symptom of a significant respiratory illness. The role of the treating clinician is to attempt to arrive at the most likely diagnosis as quickly and efficiently as possible so that therapy, if necessary, can be instituted and the caregiver's concerns can be addressed. Objectives: to discuss the assessment of wheezing in infants and children. Methodology: Integrative literature review based on scientific databases from Scielo, PubMed and VHL, from January to April 2024, with the descriptors “Assessment”, “ Wheezing”, “ Infants” AND “ Children”. Articles from 2019-2024 (total 43) were included, excluding other criteria and choosing 5 full articles. Results and Discussion:Wheezing is a common presenting symptom of respiratory disease in children. It may be a benign, self-limited process or the presenting symptom of a significant respiratory illness. Clinical history and physical examination usually allow for an accurate diagnosis (table 5). Additional diagnostic tools are useful in establishing the underlying etiology of wheezing in selected patients. When a patient presents with a history of wheezing, it is crucial to ask the patient or caregivers to describe what they are actually experiencing or hearing (or demonstrate with a home video or audio recording made on a cell phone). On many occasions, the word "wheezing" is used as a general term to describe noisy breathing, including snoring, congestion, gurgling noises, or stridor. Two important aspects of the medical history include the patient's age at the onset of wheezing and the course of onset (acute versus gradual). Certain clinical features favor the diagnosis of asthma or suggest another diagnosis. The general examination of a wheezing child should include measuring weight and height; vital signs, including oxygen saturation; digital inspection for the presence of cyanosis or clubbing; a complete chest examination; and cardiac, skin and nasal examinations. Anteroposterior (AP) and lateral chest radiographs are suggested in children with new-onset wheezing of undetermined etiology or chronic, persistent wheezing that is unresponsive to therapy. Other radiological studies, such as computed tomography (CT) and magnetic resonance angiography (MRA), may be useful in selected cases. Pulmonary function tests (PFTs) are an important component of the diagnostic evaluation of a wheezing child. In older children who are cooperative, PFT with inspiratory and expiratory flow-volume loops is useful in determining the presence, degree, and location of airway obstruction as well as the response to bronchodilators. When suspected, endoscopy can help identify FBA or structural abnormalities. For patients with suspected asthma, a trial of inhaled bronchodilators with or without glucocorticoids can be used to confirm the diagnosis before initiating a more extensive investigation. Further investigation is indicated if response to therapy is inadequate. There are few laboratory investigations that are useful in the initial assessment of a wheezing child. Any studies obtained other than chest x-rays and PFTs should be based on the suspected diagnosis. These studies include tests to examine viral, bacterial, or fungal infections; sweat chloride test to diagnose cystic fibrosis (CF), investigation for primary ciliary dyskinesia, evaluation for immunodeficiency or allergy and investigation for GER, if indicated. Conclusion: A wheeze is a continuous musical sound heard during chest auscultation that lasts more than 250 ms. It is produced by the oscillation of opposing walls of a narrowed airway almost to the point of closure. It can be high-pitched or low-pitched, consist of single or multiple notes, occur during inspiration or expiration, or biphasic, and originate from airways of any size.