Asthma - rattle, purr and whistle
28 Mar, 08 | by Ian Wacogne
In this cohort from Aberdeen, 1371 children were assessed at 2 years and their asthma symptoms subclassified into rattle, purr and whistle. At five years there was a significant difference between the groups in terms of treatment with asthma medication. Here.
It’s worth adding a line or two to this. It isn’t often that you see a paper which actually attempts to alter our clinical skills - I’d say that the vast majority of papers published by ADC look at treatments or tests. This paper looks at children who wheeze and says “Well, wheeze is more complicated than that”. It then defines rattle, purr and whistle. I’d be interested what people think of these three; I have the most trouble with purr. The question will be: Can you reproduce these categories yourself, and if you can, will you find the same things as this group?
Simple and fascinating stuff - all based around asking mums “Does the wheeze sound like a rattle, whistle or purr?”.
Do you think there’s any scope for an audio follow-up to this, with the investigators offering three MP3 of respiratory noises? (With a bit of clever web-survey monkeying, it could tell us all what degree of agreement there was between docs who listened and then classified the sounds too… could get lots of people to play!)
There are also echos of a previous Archives pieces by Elphick ( http://adc.bmj.com/cgi/content/full/84/1/35 and http://adc.bmj.com/cgi/content/full/89/11/1059) which look at how rubbish we are at describing noises. Do musically trained paediatricians do better?
bphillips
April 1st, 2008 at 11:26 am
I’ve been thinking about this paper since I’ve read it. Actually, although I’ve stated above that it defines rattle, purr and whistle, it actually doesn’t - it actually just asks parents what they think.
Now, let me ask the clinicians out there: given a child who has wheeze at how good are you at predicting whether the child will go on to have asthma at five? I think I’m pretty rubbish at it - there are some in whom it is going to be a dead cert, but the rest, well it feels pretty random. But here, from these parents’ descriptions, you’ve got a test which predicts much more strongly than I can if you’re going to continue to wheeze when you’re five.
iwacogne
April 1st, 2008 at 3:35 pm
Thanks for the comments on our paper. The crux of the clinical problem is that the lay public (and many clinicians) use the term “wheeze” to mean any respiratory sound. Thus, elicting a history of wheeze is not helpful unless further qualified. I find that whistle or rattle are the best terms to help parents more accurately describe their child’s “wheeze”. Additionally a whistle is accompanied by increased work of breathing/recession whilst rattle is accompanied by a palpable fremitus (”a cat purring”). Whilst it is useful to be able to mimic a wheeze or a rattle during the consultation, the less musical of us can still ask about associated work of breathing/palpable fremitus.
Steve Turner
April 2nd, 2008 at 2:03 pm