Early Rattles, Purrs and Whistles as Predictors of Later Wheeze

Turner SW, Craig LCA, Harbor PJ, et al. Arch Dis Child. 2008;93(8):701–704 PURPOSE OF THE STUDY. To determine how different respiratory sounds in 2-year-olds (whistles, purrs, and rattles) characterized as wheeze by parents predicted wheeze and asthma diagnosis at 5 years of age. A better understanding of parental descriptions of respiratory symptoms may lead to a more accurate diagnosis of asthma. STUDY POPULATION. The study subjects were children followed at 2 time points: at ages 2 and 5 years. They were recruited randomly before birth irrespective of history of parental asthma and allergy. METHODS. Two thousand pregnant women were recruited randomly at 12 weeks’ gestation, initially as part of a longitudinal birth cohort designed to relate dietary exposure in early life to asthma outcomes in childhood. Parents filled out questionnaires by mail regarding respiratory symptoms when their children were aged 2 and 5 years. Questions included, “Has your child ever suffered from asthma?” and “Has this been diagnosed by a doctor?” Current wheeze was defined as wheezing that has occurred over the last 12 months. If present, parents were asked to categorize the wheeze by sound, describing it as a whistle, rattle, purr, or other sound. If “other sound” was designated, the subjects were excluded from the analysis. RESULTS. A total of 210 children wheezed as determined by the questionnaire at 2 years of age, and 77% (162) of the parents of these children also returned a questionnaire when the child was 5 years old. Wheeze persisted in 62 of these subjects. At 5 years of age, children with “whistle” at age 2 were more likely to have current wheeze (73% [11 of 15]) with physician-confirmed asthma (67% [10 of 15]). They were also more likely to be on asthma treatment (40% [6 of 15]). This was compared with “rattle,” which only translated to a 34% (33 of 97) incidence of current wheeze at age 5 and 42% (43 of 97) with physician-confirmed asthma, with 11% (11 of 97) on asthma therapy. A description of “purr” at age 2 had similar outcomes to that of rattle. Children with whistle at 2 years of age were more likely to have mothers with asthma, whereas children with rattle and purr were more likely to be exposed to environmental tobacco smoke. CONCLUSIONS. Parents often interpret any respiratory sound as “wheeze.” When respiratory sounds are further characterized as whistle, rattle, or purr, a parent using the terminology “whistle” to describe his or her child's wheeze was a good predictor of persisting symptoms and was associated with future asthma treatment. Use of terms “rattle” and “purr” did not predict future wheeze particularly well. REVIEWER COMMENTS. In pediatric medicine, physicians must rely on parents for the history. For children with respiratory symptoms, parents often do not understand or know what “wheeze” means. Having parents use terms such as whistle, rattle, or purr to characterize the noise they hear may help physicians make a diagnosis of asthma, especially if the term whistle is used.