Lee H, Arroyo A, Rosenfeld W
Department of Pediatrics, Winthrop-University Hospital, State University of New York/Stony Brook School of Medicine, Mineola 11501, USA.
Chest. 1996 Jan;109(1):91-3. doi: 10.1378/chest.109.1.91.
Wheezing is a widely used physical sign of asthma that physicians assess in evaluation of their asthmatic patients. It may be possible to teach the parents to recognize it and to assess its severity so as to help them make better informed judgment in monitoring their children with asthma.
Parents were taught to recognize wheezing by placing their ear over the chest and in front of the open mouth of their child. One session lasting a few minutes was sufficient for teaching. Subsequently, the parent and a physician evaluated the child independently for the presence and the severity of wheezing categorized as easily, barely, and none detected, and results were compared. Severity of wheezing was also compared with peak expiratory flow rate (PEFR) whenever possible.
Six hundred thirty-six observations were made in 89 parent-child pairs. Wheezing was detected by the physician in 64% of examinations and by the parents in 56% (p < 0.001 by chi 2). When the physician heard the wheezing easily on 240 occasions, the parents also heard it in 99%. When the physician heard the wheezing barely on 170 occasions, the parents heard it only on 68% of the time. Mean PEFR was 55% predicted when the parents heard the wheezing easily, 75% when heard barely, and 93% when not heard (the difference is significant, p < 0.001 by analysis of variance).
Parents can be taught to detect wheezing in their child with considerable accuracy when it is easily detectable to a physician. Such skills should be helpful to the parents in monitoring their child with asthma and in deciding when to increase medications and when to seek emergency care.
