WHEEZING IS COMMON AMONG FILIPINO CHILDREN TREATED FOR PNEUMONIA

Laura Rautio^1,2, Taneli Puumalainen¹, Edgardo Epe⁴, Sirpa Aaltonen^1,4, Beatriz Quiambao³, Petri Ruutu¹, Socorro Lupisan³, Matti Korppi², Marilla Lucero³, Hanna Nohynek¹

¹National Public Health Institute (KTL), Finland; ²University of Kuopio, Finland; ³Research Institute for Tropical Medicine (RITM), the Philippines; ⁴Bohol Regional Hospital (BRH), the Philippines

Background: Wheezing as a sign of respiratory distress may confound the WHO criteria widely used in developing countries for management of pneumonia in children. Little is known about its prevalence in relevant patient-populations.

Methods: From September 25 to November 17, 2000 (rainy season) all children with respiratory symptoms aged 6 weeks to 23 months consulting at Out Patient Department (OPD) or 6 weeks to 59 months admitted to BRH were evaluated for respiratory signs including inspiratory stridor and expiratory wheezing using a structured questionnaire and classified according to WHO criteria for pneumonia. Study area were the 6 municipalities of Bohol participating in a randomized, controlled pneumococcal conjugate vaccine effectiveness study. Oximetry, white blood cell count and chest X-ray were taken.

Results: 38/73 (52%) of hospitalized and 58/166 (35%) of OPD attended children were wheezing. The proportion of wheezing children within each WHO category of pneumonia were:

WHO category	Hospitalized	OPD	TOTAL	Risk ratio
Pneumonia	1/6 (17%)	58/165 (35%)	59/171 (35%)	1.59 (95%CI 1.17-2.15)
Severe pneumonia	35/63 (56%)	0/1 (0%)	35/64 (55%)
Very severe pneumonia	2/4 (50%)	0/0 (0%)	2/4 (50%)
TOTAL	38/73 (52%)	58/166 (35%)	96/239 (40%)

Conclusions: Wheezing is common among Filipino children with respiratory symptoms during the rainy season. The WHO classification originally meant for screening and referral of pneumonia in developing countries may not be specific enough in differentiating wheezing associated diseases from childhood pneumonia requiring antibiotic treatment.