Clinicians often hear parents of asthmatic children tell them their child is wheezing. But parents' definition of wheezing usually is different from that of physicians.
When is a wheeze not a wheeze?
According to a recent study published in BMC Pediatrics, the answer is, "most of the time" or at least when reported by a patient's parents when English is not their main language.
In the study, when parents were asked to discern a wheezing sound from among a series of recorded respiratory sounds they were usually wrong. Consequently, the study suggests, medical professionals should be alert to potentially inaccurate parent reporting of wheezing by their asthmatic children.
The study, conducted at the University Malaya Medical Centre (UMMC) in Kuala Lumpur, Malaysia, underscored the significance of noisy breathing as a symptom of acute and chronic respiratory disease, and the likelihood of parents accurately identifying their kids’ wheezing sounds; it comprised 200 parents — half (100) with asthmatic children and a control group of 100 without – that visited the center’s pediatric asthma clinic, and included participants from a wide cross section of cultural and socioeconomic backgrounds. Data was collected for the period Jan 1, 2012 – June 30, 2013, and excluded parents that could not communicate fluently in English and/or Malay (with Malay being the preferred language of 75% of respondents).
The structure of the assessment centered around a series of video clips of children making audible respiratory sounds. The noise in each clip was categorized by the authors as normal, showing wheeze, stridor, transmitted noises, or snoring. Experienced pediatricians were used to validate the category assigned to each of the 21 videos ultimately employed. While viewing the video (up to three times), the parents were queried as to: 1) the name of the sound (the “label question”), and 2) where the sound was originating (the “location question”).
The results demonstrated that only 38.5% of parents overall correctly labeled “wheeze” (OR 2.4, 95% CI 1.64-3.73). Perhaps more surprisingly, the group of parents of asthmatic children were not more successful in identifying this sound (OR 1.04, 95% CI 0.59-1.84), though participants that responded in English (OR 3.4, 95% CI 1.69-7.14) or who had older children with asthma (OR 9.09, 95% CI 3.13-26.32) answered more accurately. Moreover, parents were more successful at locating the origin of the wheeze.
While recognizing the small sample and potential drawbacks to their study methods, the authors point to the “limitations of using the word ‘wheeze’…when eliciting a history from parents [of children with asthma].” This was especially true, in the present case, where English was not the native language.