The spectrum of voice disorders – classification
There have been many approaches to the classification of voice disorders over the years, with experts attempting to find agreement on the best system of classification. The choice of a classification system may well be determined by the clinician’s place of work and working practice. This chapter explores the spectrum of voice disorders and offers practical descriptions of those disorders most commonly found on clinical caseloads. Mutational Falsetto has been variously described by authors as occurring in a post-adolescent male who continues to have a pre-adolescent voice, or as Juvenile Voice, when a post-adolescent female has the vocal qualities of a child. In the case of a post-adolescent male, it is also known as Puberphonia or Persistent Falsetto. Inducible Laryngeal Dysfunction, or Vocal Cord Dysfunction, typically involves abnormal adduction of the vocal folds during inspiration and mimics the symptoms of asthma with intermittent wheeze and dyspnoea.
Case 65 Wheeze and productive cough
A 36-year-old woman has presented with severe shortness of breath associated with wheeze and productive cough. She was diagnosed with asthma at age 10 years. Until a year ago she had never been admitted to hospital, but since then she has been admitted three times with asthma exacerbations. She also complains of a chronic productive cough with large quantities of thick, dark sputum that is hard to expectorate. There is no other medical history, including sinusitis. She has never smoked. There is no travel history. She is taking salbutamol inhaler, 2 puffs four times daily; Seretide 250, 2 puffs twice daily; montelukast, 10 mg once daily; Uniphyllin Continus, 200 mg twice daily.
Case 66 Wheeze and shortness of breath
A 38-year-old man has presented to the emergency department with shortness of breath and wheeze. On arrival he was in extremis and unable to complete a full sentence. He was discharged from the hospital one week ago after acute severe exacerbation of chronic obstructive pulmonary disease (COPD), ﬁrst diagnosed three years ago. This is his third casualty attendance over the past 12 months. He smokes ﬁve cigarettes a day. He is now awaiting investigation for deranged liver function tests. His father died of a chest disease in his 30s. He is taking salbutamol inhaler p.r.n.; tiotropium, 18 mg once daily; Symbicort 6/200, 2 puffs daily; carbocisteine, 375 mg thrice daily; Uniphyllin Continus, 400 mg twice daily.
Household Conditions, Eczema Symptoms and Rhinitis Symptoms: Relationship with Wheeze and Severe Wheeze in Adolescents Living in the Polokwane Area, South Africa
Published in Journal of Asthma, 2007
Objective. Determine the prevalence and risk factors of wheeze and severe wheeze in 13-to 14-year-old children. Methods. The study was conducted August 2004 to February 2005 in the Polokwane area, South Africa. Results. The 12-month prevalence rate was 18.9% for wheeze and 9.2% for severe wheeze (n = 3,926). The presence of other allergic symptoms and industrial activities appear to increase the likelihood of wheeze, even more so for severe wheeze. Socioeconomic-related factors appear to have a protective effect on wheeze. Conclusions. Wheeze appears to be a substantial public health problem in the Polokwane area.
A Comparison of Virus-Associated and Multi-Trigger Wheeze in School Children
Published in Journal of Asthma, 2005
To examine differences between virus-associated wheeze and wheeze associated with other triggers (multi-trigger wheeze) in elementary school children, we performed a cross-sectional school-based questionnaire study of 5,998 children mainly 7 to 12 years of age, with outliers 6 and 13 years of age. Using parent-completed questionnaires, we identified 522 children who wheezed only during upper respiratory tract infections (virus-associated wheeze), 1,186 children who wheezed on other occasions (multi-trigger wheeze), and 4,290 children with no wheeze. In comparison with children who had multi-trigger wheeze, children with virus-associated wheeze were more likely to be male, to be younger, and to have less frequent wheezy episodes. They were less likely to have night cough, shortness of breath or chest tightness, to have a personal or parental history of atopic disorders, to have a diagnosis of asthma, or to be receiving asthma treatment. Both types of wheeze were associated with social deprivation, a relationship that persisted after controlling for family smoking. Virus-associated wheeze is a common but diminishing problem in this age group, and the differences between virus-associated wheeze and multi-trigger wheeze already noted in pre-school children persist in this older age group.
Blowing the Whistle: What do African American Adolescents with Asthma and Their Caregivers Understand by “Wheeze?”
Published in Journal of Asthma, 2010
Aims: To investigate what African American adolescents with asthma and their caregivers understand by “wheeze”. Methods: Caregivers (n = 35) and adolescents (n = 35) were each asked to describe what they understood by “wheeze”. Respondents were also shown a video clip of an adolescent wheezing and asked: a) to describe the breathing of the adolescent in the video; and, b) whether the adolescent respondent's breathing had ever been similar to the video-presented symptoms. Results: Most caregivers described wheeze in terms of sound alone (61.8%) while the majority of adolescents described wheeze as something that is felt (55.8%). Few caregivers and adolescents (5.8% each) included “whistling” in their descriptions of “wheeze”. Most caregivers and adolescents used the word “wheeze” when describing the video clip, but nearly one-quarter of the caregivers and one-third of the adolescents felt that the adolescent's breathing was never similar to the video. Conclusion: Caregiver and adolescents descriptions of wheeze are different from each other and both may be different from clinical definitions of the term. Study findings have implications for the ways in which questions about “wheeze” are framed and interpreted.