Key Message
Wheezing and rattling are two distinct types of noisy breathing with
different underlying pathological mechanisms, different treatment
options and different long-term scenarios. However, rattling infants are
often mislabelled as wheezing leading to overtreatment with
bronchodilators and/or inhaled corticosteroids (ICS). ICS will not
benefit the rattling infant, but can have adverse effects on linear
growth potentially causing significant growth reduction. Currently there
are no objective diagnostic tools to diagnose noisy breathing infants
and the clinician can solely rely on auscultation, parent reports and
physical examination. There is a need for non-invasive and objective
techniques to achieve early differential diagnosis which is of high
importance for a “precision medicine” approach to prevent under- and
overtreatment. In the Non-invasive Noisy breathing Infant study showed
that the analysis of exhaled volatile biomarkers could have potential as
a clinical tool for detection and classification of rattling in infants.
Future research should investigate the potential of exhaled breath to
differentiate wheezing and rattling infants.