In this chapter, we will talk about wheezing, as we often see children who come to the clinic with wheezing. First, we need to clarify the concept of what “wheezing” (or simply “wheezing”) is. One of the biggest problems I’ve found when dealing with children with wheezing as the main complaint in the clinic is that many times the parents refer to “wheezing The biggest problem I have found is that many times what parents call “wheezing” or “wheezing” is different from the medical concept, which can easily lead to misleading diagnosis and treatment. So let’s clarify the concept of “wheezing” or “wheezing”: “wheezing/gasping” is a narrowing of the bronchial lumen due to various causes (inflammation, malformation, foreign body blockage, etc.). The air flow in and out of the bronchus is not smooth, causing the gas to flow out of the bronchus during exhalation and causing the airflow sound like a “whistle” and resonance of the bronchial wall. The specific characteristics of the sound can be heard by clicking on this link: http://www.med126.com/radio/mp.html?u=lung/wrpb008.asx. One point to emphasize: as shown in the audio above, the wheezing sound can be heard in the expiratory phase, and the expiratory phase is significantly longer. This will happen because the bronchial obstruction in the chest cavity will make it difficult to exhale because of the air pressure problem that allows gas to be inhaled into the lungs. Once this concept is clarified, you can determine for yourself whether the breathing problem your child is experiencing is wheezing or not. This audio is a sound recorded in a stethoscope. You can bring your own stethoscope at home, and when you suspect that your child has wheezing, use the stethoscope to place it on the front and back of the lungs and listen for the presence of the above sound with the child’s breathing movements. If there is, you can basically tell that it is what is known medically as wheezing. Some children can hear this wheezing sound when they breathe even without a stethoscope. The most common and correct metaphors used by families are: hissing, pulling a bellows, whistling, and heaving. ……, etc. What some parents call “wheezing” is actually something else when I ask about it in the clinic, and the common ones include: shortness of breath (fast breathing), throat grunting (phlegm sound), snoring, and laryngeal sounds (the difference from wheezing is that laryngeal sounds are inspiratory dyspnea that occurs when inhaling, and the sound is very shallow, mostly in the throat and It is caused by obstruction in the upper part of the trachea outside the pharynx or chest cavity, and is commonly associated with acute laryngitis, foreign bodies in the trachea, malformations in the pharynx, etc.), pseudo-gasping sounds (some normal people can imitate a gasping sound by deliberately contracting the larynx or increasing the force of exhalation while exhaling forcefully), and so on. In addition to the above-mentioned distinction, it is also important to know that wheezing is caused by bronchial obstruction in the chest cavity, so a child with wheezing will have one or more of the following symptoms: breath-holding, chest tightness, chest pain, coughing and coughing. In the most severe cases, the child can become irritable, breathe very shallowly (by this time, the wheezing is no longer audible because of the severe obstruction), and even become unconscious. Once the concept of wheezing is understood, let’s talk about what to consider in a child with recurrent wheezing. There are many causes of recurrent wheezing, including: wheezing bronchitis, pneumonia, pneumonia sequelae, bronchial foreign body, tracheobronchial malformation, asthma, pulmonary cystic fibrosis, occlusive bronchitis (BO), etc. According to the concept of wheezing, we can imagine that any condition that can cause bronchial obstruction in the chest cavity can cause wheezing. What exactly is the case in each child specifically requires that we must analyze each child in relation to its characteristics and perfect the necessary relevant tests. Repeated wheezing in children is not always asthma either. The recurrent wheezing in childhood, excluding wheezing with clear etiology such as bronchial foreign bodies, pulmonary sequelae of pneumonia, occlusive fine bronchitis, etc., can be roughly divided into two categories: The first category starts relatively early, even just after birth or a few months after birth, mostly related to respiratory infections, and not caused by exposure to allergic things, when not wheezing nothing is affected, physical strength is also good, and there is no obvious Most of the children have allergic rhinitis, most of the allergens are negative, and there is no family history of asthma in the family. Because these children have an early onset of the disease, attention must be paid to rule out airway developmental abnormalities. The second type of children generally have a later onset, most of them appear after 3-4 years old, mostly related to allergies, infections can also be triggered, when they are not wheezing, they may have intermittent coughing and other symptoms, especially after sports, and their strength for activities gradually decreases, most of them have eczema, allergic rhinitis and other allergic diseases, they are positive for inhalant allergens, some of them have a family history of asthma, and the number of wheezing increases with age and irregular treatment, and some of them have a gradual increase in severity. Some of them have a family history of asthma. In this category, the diagnosis of “asthma” should be considered. However, further exclusion of other diseases is needed. How to exclude other diseases? By other diseases, we mean bronchial foreign bodies, developmental malformations, cystic fibrosis, occlusive bronchitis, pneumonia sequelae, and other intrinsic lung conditions, because most of these diseases have a clear history and other accompanying symptoms (for example, for bronchial foreign bodies, most children can be asked about a history of sudden choking when eating or touching small toys; for occlusive bronchitis and pneumonia sequelae, there is basically a history of severe pneumonia). The child can be seen on a chest X-ray or lung CT, so asking questions and taking a chest X-ray and, if necessary, a “lung CT + airway reconstruction” can help rule it out. However, no two leaves are alike, and each child is different. In many cases, the child’s specific condition is not as typical as it is written in the textbook, so it is necessary to have a diagnosis at the first consultation and then to observe the child’s results after treatment. Conclusion: Through today’s introduction, I hope you know what the medical definition of “wheezing” is, and have a general impression of which direction to consider for your child’s condition. It is recommended that you review your child’s characteristics before bringing him/her to the clinic, and record the important points, such as the overall length of the history of recurrent wheezing (how long has it been since the first episode?) The frequency of wheezing (approximately how many times per year?) What are the triggers of wheezing (infection? Odor? environment? ……), and what laboratory tests have been done (it is best to bring all laboratory test results, as well as the medical records from previous visits to other hospitals for wheezing), so that you can reduce a lot of communication problems during the visit. Lastly, I hope your visit goes well and your child recovers soon, and feel free to ask questions.