Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Wheezing is when the air flowing into the lungs makes a high-pitched whistling sound.
Mild wheezing occurs only at the end of a breath when the child is breathing out (expiration or exhalation). More severe wheezing is heard during the whole exhaled breath. Children with even more severe asthma can also have wheezing while they breathe in (inspiration or inhalation). However, during a most extreme asthma attack, wheezing may be absent because almost no air is passing through the airways.
Asthma can occur without wheezing and be associated with other symptoms such as cough, breathlessness, chest tightness. So wheezing is not necessary for the diagnosis of asthma. Also, wheezing can be associated with other lung disorders such as cystic fibrosis.
In asthma related to exercise (exercise-induced asthma) or asthma that occurs at night (nocturnal asthma), wheezing may be present only during or after exercise (exercise-induced asthma) or during the night, especially during early part of morning (nocturnal asthma).
Coughing: Cough may be the only symptom of asthma, especially in cases of exercise-induced or nocturnal asthma. Cough due to nocturnal asthma (nighttime asthma) usually occurs during
the early hours of morning, from 1 a.m. to 4 a.m. Usually, the child doesn't cough anything up so there is no phlegm or mucus. Also, coughing may occur with wheezing.
Chest tightness: The child may feel like the chest is tight or won't expand when breathing in, or there may be pain in the chest with or without other symptoms of asthma, especially in exercise-induced or nocturnal asthma.
Other symptoms: Infants or young children may have a history of cough or lung infections (bronchitis) or pneumonia. Children with asthma may get coughs every time they get a cold. Most children with chronic or recurrent bronchitis have asthma.
Symptoms can be different depending on whether the asthma episode is mild, moderate, or severe.
Symptoms during a mild episode: Children may be out of breath after a physical activity, such as walking
or running. They can talk in sentences and lie down, and they may be restless. The feeding may be with interruption, therefore, the infant takes longer to finish the feed.
Symptoms during a moderately severe episode: Children are out of breath while talking. Infants have a softer, shorter cry, and feeding is difficult. There is feeding with interruption and
the child may not be able to finish the usual quantity of the feed.
Symptoms during a severe episode: Children are out of breath while resting, they sit upright, they talk in words (not sentences), and they are usually restless. Infants are not interested in feeding and are restless and out of breath. Infant may try to start feeding but cannot sustain feeding due to breathlessness.
Symptoms indicating that breathing will stop: In addition to the symptoms already described, the child is sleepy and confused. However, adolescents may not have these symptoms until they actually stop breathing. The infant may not be interested in feeding.
In most children, asthma
develops before 5 years of age, and in more than half, asthma develops
before 3 years of age.