Pertinent issues in diagnosis and management of wheezing in under-five children at community level.

Wheezing in acute respiratory infections is a rule rather than exception. A large proportion of children (up to 75%) having pneumonia or severe pneumonia as per WHO definitions have associated wheezing. The current strategies to diagnose and manage wheeze in the community need to be updated, as audible wheeze is present in only less than one third of wheezy children, and can not be relied upon solely. A history of previous episodes of respiratory distress has a high sensitivity to diagnose wheezy disorders. In a significant proportion of children, the respiratory rate comes back to normal and the chest indrawing disappear after two to three cycles of inhaled bronchodilator medications. Operational research is needed to evaluate the feasibility of including management of wheezing in the community based ARI management programs.