Bronchiolitis / Wheezing – 3-24 Months

Wheezing is a common complaint on radio traffic. In infants, wheezing is most likely due to bronchiolitis or asthma. Listen carefully for a history of recurrent wheezing in the past as a clue toward asthma. For infants presenting for the first time or with associated stridor, think foreign body. Wheezing in older children should not be diagnosed as “bronchitis” as this is not a disease seen in children. Older wheezing children have asthma, a viral process or pneumonia. Be tuned in to a reported past history that points to undiagnosed bronchiectasis (productive cough greater than 3 months). These children should be seen in Pediatric Clinic for an evaluation.

Pathophysiology:
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Resources/References

• Lewis, T. et al. Prevalence of Asthma and Chronic Respiratory Symptoms Among Alaska Native Children. CHEST. 125(5):1665-1673, May 2004. doi.org/10.1378/chest.125.5.1665
• Respiratory Hospitalizations in the Delta (Powerpoint Presentation by Rosalyn Singleton, MD)
• Bronchiolitis/Wheezing YKHC Clinical Guideline
• Martinez, P; Weiss, B. Unchanged asthma prevalence during 1990–1999 in rural Alaska Native. International Journal of Circumpolar Health, 65:4, 341-346, DOI: 10.3402/ijch.v65i4.18119
• Ware, D.N. et al. (2014) Household reporting of childhood respiratory health and air pollution in rural Alaska Native communities. International Journal of Circumpolar Health 73:1.
• Trends in asthma prevalence, hospitalization risk, and inhaled corticosteroid use among Alaska Native and non-Native Medicaid recipients less than 20 years of age. State of Alaska Epidemiology Bulletin, 2004.
• Singleton, R. et al. Asthma Hospitalizations Among American Indian and Alaska Native People and for the General US Population. Chest. 2006, Nov. 130(5):1554-1562. doi.org/10.1378/chest.130.5.1554
• Bruden, D. et al. Eighteen Years of Respiratory Syncytial Virus Surveillance: Changes in Seasonality and Hospitalization Rates in Southwestern Alaska Native Children. Pediatr Infect Dis J. 2015;34(9):945-950. doi:10.1097/INF.0000000000000772
• RSV in Alaskan Native Infants from the CDC.
• Improving Health for Alaska and Arctic Residents: Arctic Investigations Program through the CDC

category:YKHC Guidelines
Common/Unique Medical Diagnoses