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Editorials |

Evaluating Noisy Breathing in Children : How Far Down the Airway Should One Look?

Edward R. Carter
Author and Funding Information

Affiliations: Seattle, WA
 ,  Dr. Carter is Associate Professor of Pediatrics, University of Washington School of Medicine.

Correspondence to: Edward R. Carter, MD, FCCP, Mail Stop 3D-4, Children’s Hospital & Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105; e-mail: 5carter@msn.com



Chest. 2004;125(4):1184-1186. doi:10.1378/chest.125.4.1184
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The Renaissance biographer Giorgio Vasari quotes Donatello saying to his good friend and fellow artist Paolo Uccello: “Eh, Paolo, this perspective of yours makes you leave what is certain for the uncertain….”1 While Donatello was referring to the art of painting, these words pertain just as well to the art of medicine. Indeed, our perspective affects how we manage patients, and this is definitely true when evaluating children with noisy breathing. Noisy breathing, especially in infants, is a common problem, and its evaluation is not always straightforward. The workup will depend on one’s perspective (eg, training, experience, and patient population). Primary care providers encounter many of these patients first, often make the diagnosis without using invasive diagnostic aids, and refer only a few to specialists. Patients referred to specialists are more likely to undergo fiberoptic nasopharyngoscopy (NP) and flexible fiberoptic bronchoscopy (FB). Otolaryngologists routinely perform NP in the clinic setting without proceeding to FB, while pulmonologists are more likely to look further down the airway via FB.

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