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determine if wheezy infants with complex repetitive sounds

rather than typical wheezes may be at a lower risk for future
manifestations of asthma.
Spontaneous wheeze is often present during inspiration in
adults (114) and children (115) with asthma, a situation that
healthy subjects cannot reproduce even during forced maneuvers.
Regional flow limitation during inspiration is a possibility
but has not been proven. Spontaneous wheeze may also occur
during tidal breathing, with low transpulmonary pressures
and at very low airflows (61, 116). This may suggest a generation
mechanism of spontaneous wheeze by vortex-induced vibrations,
which requires much lower flow velocities and does
not depend on flow limitation (117).
The musical sound of wheezing is easily recognized by ear
since it stands out from the noise of normal lung sounds.
Wheeze of medium to loud intensity is also easy to notice as
sharp peaks in the power spectrum of respiratory sounds.
Computer-based detection of wheeze is possible with algorithms
that relate the amplitude of these spectral peaks to the
average lung sound amplitude (105, 118, 119). When wheezing
is faint but still audible, the automated recognition by computer
becomes more difficult. Digital sonography (see Figure
4) translates the acoustic information into graphic images (120),
which allows the visual identification of wheezes even at low
intensities.
Quantification of wheeze over time has been used to express
wheeze severity relative to flow obstruction. The proportion
of the breath cycle occupied by wheezing (Tw/Ttot)
was inversely related to the FEV1 in adult asthmatics with
moderate to severe flow obstruction (118) and to FEV1, maximal
midexpiratory flow, and specific conductance in adolescents
with exercise-induced bronchospasm (121). Wheeze
quantification offers a possibility for noninvasive monitoring
in nocturnal asthma. The first promising applications were reported
more than 10 yr ago (122, 123). Advances in comp