Term “viral wheeze” is wrong considering the finding of pathogenic bacteria in 86% of wheezy episodes in children

Wheezy episodes in young children are often triggered by viral and bacterial respiratory tract infections. 283 children from the Copenhagen Prospective Study on Asthma at-risk birth cohort were prospectively examined for common airway pathogenic bacteria and viruses during acute wheezy episodes in the first 3 years of life.

Here is what wheezing sounds like (click to play the embedded video):

Both viruses and bacteria were identified in 55% of episodes, bacteria were identified exclusively in 31% of episodes, and viruses were identified exclusively in only 10% of episodes (837 samples were analyzed). The median duration of acute symptoms was 9 days and duration was independent of bacterial or viral species.

The common term viral wheeze seems inappropriate in view of the finding of pathogenic bacteria in 86% of wheezy episodes.


Duration of wheezy episodes in early childhood is independent of the microbial trigger. Christian J. Carlsson et al. JACI, November 2015, Volume 136, Issue 5, Pages 1208–1214.e5.

Disclaimer: I have been the Editor of the World Allergy Organization (WAO) Small Airways Working Group "What's New?" monthly summary since 2011. The summary features the top 3 asthma/small airways articles each month. The article above is part of the project. The archive is here: http://www.worldallergy.org/small_airways_group/reviews/archive.php

Comments from Twitter:

Raymond Cattaneo @racb33: How do they know it was the bacteria instead of the virus causing the wheezing in those 55% with both?

Claybacca Jones @skepticpedi: Yeah, this doesn't add up. Viral symptoms nearly ubiquitous, CXRs often with viral patterns. Get better without antibiotics.

Raymond Cattaneo @racb33: I agree! I'm missing a lot of bacterial infxns if this is true!

Claybacca Jones @skepticpedi: Or maybe we should be treating bacterial CAP with steroids and albuterol.

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