A 4 year old boy with recurrent wheeze and chest infections

doi:10.1136/bmj.b1255

Published 29 April 2009, doi:10.1136/bmj.b1255
Cite this as: BMJ 2009;338:b1255

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A 4 year old boy with recurrent wheeze and chest infections

Atul Gupta, specialist registrar in paediatric respiratory medicine, Donald S Urquhart, specialist registrar in paediatric respiratory medicine, Sarah Donovan, paediatric respiratory technician , Andrew Bush, consultant and professor

¹ Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP

Correspondence to: Atul Gupta atulgupta@doctors.org.uk

The first 150 words of the full text of this article appear below.

A 4 year old boy presented with a history of recurrent wheezeand chest infections over the previous two years, which hadcaused him to be admitted to hospital many times. Previous chestradiographs had shown right middle and lower lobe changes. Theepisodes had been treated with antibiotics with limited effect.Treatment for asthma (a bronchodilator and steroid inhalers)also failed to improve the situation. He was admitted for a24 hour investigation, a 20 hour epoch of which is displayedbelow (figure).

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Twenty hour trace

1 What is the name of the investigation shown?

2 What is theabnormality shown?

3 What are the limitations of the test?

4 How should it be treated?

1 Oesophageal pH monitoring, which is used widely as an indexof oesophageal acid exposure—it measures the frequencyand duration of episodes of acid reflux.¹ ²

2 Multiple episodesof gastro-oesophageal reflux—113 refluxepisodes . . . [Full text of this article]