From the Guidelines
Wheezing is not a typical symptom of pneumonia, but it can occur in certain types of pneumonia, particularly those caused by atypical organisms like Mycoplasma pneumoniae, or in viral pneumonias, as noted in the British Thoracic Society guidelines for the management of community-acquired pneumonia in childhood 1. When considering the clinical features of pneumonia, it's essential to prioritize the most recent and highest quality evidence. According to the British Thoracic Society guidelines 1, wheezing is not a useful sign for determining severity in infants and young children. In fact, the guidelines suggest that if wheeze is present, a primary bacterial pneumonia is very unlikely, and a viral or mycoplasmal infection should be considered instead.
Some key points to consider when evaluating pneumonia symptoms include:
- Respiratory rate is a helpful indicator of pneumonia severity, particularly in infants under 1 year, with a rate of >70 breaths/min having a sensitivity of 63% and specificity of 89% 1.
- High fever is an important sign in both infants and children, and difficulty breathing (breathlessness) is more helpful than breath count in diagnosing pneumonia 1.
- Crackles and bronchial breathing are more characteristic findings in pneumonia than wheezing, with a sensitivity of 75% and a specificity of 57% 1.
- Wheezing occurs in 30% of mycoplasma pneumonias and is more common in older children, which can lead to confusion with asthma diagnosis 1.
In clinical practice, it's crucial to consider the entire clinical picture, including symptoms, signs, and patient history, to make an accurate diagnosis and develop an effective treatment plan. The presence of wheezing in pneumonia should prompt consideration of atypical or viral causes, rather than typical bacterial pneumonia 1.
From the Research
Wheezing in Pneumonia
- Wheezing is a common symptom associated with various respiratory conditions, including asthma, chronic obstructive pulmonary disease, and pneumonia 2, 3.
- Pneumonia can cause wheezing due to the narrowing of bronchioles and the presence of fluid in the alveolar sacs, leading to impaired oxygenation 2.
- A study on community-acquired pneumonia found that patients with pneumonia may exhibit wheezing as a symptom, although the study did not specifically focus on the prevalence of wheezing in pneumonia patients 4, 5, 6.
- The evaluation of wheezing in adults typically includes a chest x-ray and pulmonary function testing with bronchodilator challenge, and advanced imaging may be considered in patients with a significant history of tobacco use and new-onset wheezing 3.
Differential Diagnosis
- Wheezing can be caused by various conditions, including anaphylaxis, asthma, bronchitis, pneumonia, and congestive heart failure (CHF) 2.
- A thorough assessment and patient history are essential to determine the underlying cause of wheezing, as the treatment approach may vary depending on the diagnosis 2.
Treatment Approach
- The treatment of wheezing in pneumonia patients may involve the use of antibiotics, bronchodilators, and other medications to manage symptoms and underlying conditions 4, 5, 6.
- In patients with CHF, the use of beta-2 selective breathing treatments, nitrates, and diuretics may be appropriate to manage wheezing and improve oxygenation 2.