Auscultation Using a Pinwheel in Young Children Presenting With Cough

Abstract

Background:

Ausculation of tidal breathing may not show evidence of wheezing. Forced expiratory maneuvers can bring out wheezing in children; however, it can be difficult to motivate a young child to perform a forced expiratory maneuver.

Objectives:

This study was performed to determine whether auscultation using a pinwheel to motivate a forced expiratory maneuver would be useful to elicit wheezing in young children with a history of asthma presenting to a general clinic for cough only.

Materials and Methods:

Subjects. One hundred and forty children aged 3.9 (SD 0.7) years with a history of asthma who had not been symptomatic for ≥3 months, who presented for cough, and who did not have wheeze on normal auscultation. Subjects were randomly assigned to 1 of 2 groups of 70 each: Group A: normal ausculation with no aids to motivate forced expiration. Group B: auscultation during forced expiration elicited by having the child blow out on a pinwheel. Patients in Group B in whom wheezing was detected (Group B-1, n = 47) were given asthma therapy with montelukast and a β-agonist. Patients in Group B in whom wheezing was not detected (Group B-2, n = 23) and all of those in Group A (n = 70) were given treatment for an upper respiratory tract infection. Results. The frequency of returning to clinic with wheezing was significantly higher in Group A (57.1%) than in Group B (27%) (P < 0.001).

Conclusions:

Having a young child blow out into a pinwheel can allow detection of wheezing that was not present on quiet breathing, and thus can improve confidence in the diagnosis of an asthma exacerbation.