Resolved question:
I have an eight year old male child that has had difficulty breathing for as long as I can remember, I was listening to him today and it sounds like he is trying to hold his breath every single time he breathes. I hear a lot of effort when he exhales, do you have an ideas what I could be dealing with?
Submitted:
4 Days
Category:
Pediatrician
Dear Parent,
I understand your concern. By your description, he seems to be having some form of expiratory obstruction/ bronchospasm. I am going to request you to give me more information regarding your son's illness, before I can give you any meaningful explanation:
Does he have only respiratory complaints and no fever?
Does his respiratory problem worsen all of a sudden?
Do you hear a whistling/ musical note when he exhales?
Does he have more problems during night/ early morning?
Does anyone in the family have allergy/ atopy/ asthma?
Does he have seasonal or exercise induced exacerbations?
Does he show response to nebulisation with bronchodilators?
Has he been treated as asthma before?
Is he growing appropriately for his age? Is he otherwise normal?
Regards
Saptharishi L G
Dr. Saptharishi L G
DM (Pediatric Critical Care) Senior Resident
MBBS, MD (Pediatrics), PGDCRL
Division of Pediatric Critical Care
Dept. of Pediatrics
Advanced Pediatrics Center
Post-Graduate Institute of Medical Education & Research
Does he have only respiratory complaints and no fever?
He has had this condition so long that he no longer thinks of it, no fever connection
Does his respiratory problem worsen all of a sudden?
No
Do you hear a whistling/ musical note when he exhales?
I hear whistling both when he inhales and exhales
Does he have more problems during night/ early morning?
It is the same
Does anyone in the family have allergy/ atopy/ asthma?
Not that we know of.
Does he have seasonal or exercise induced exacerbations?
It does with too much exercise.
Does he show response to nebulisation with bronchodilators?
He has never used either of those devices
Has he been treated as asthma before?
No
Is he growing appropriately for his age? Is he otherwise normal?
His height and weight are appropriate with this of someone his age. He is a normal boy in just about every other aspect.
Dear Parent,
Thank you for the details. I have just one more clarification. Does your child have episodes of this problem or is the problem persisting throughout the day?
Based on your description that he has whistling noise during breathing and if the problem is recurrent/ episodic, the diagnosis could be Bronchial Asthma. If the problem that you have described is present almost continuously, it could be an upper airway obstruction due to a congenital/ acquired cause.
In either case, it is necessary to get the child evaluated (in person) by a paediatrician/ paediatric pulmonologist. If your child fits into the clinical spectrum of Asthma, your child may require some form of preventive therapy in the form of inhaled steroids and controller therapy in the form of inhaled bronchodilators. depending on other factors your doctor may decide regarding need for an anti-leukotriene drug (Montelukast).
Regards
Saptharishi L G