Wheezing in infancy - not every wheeze is asthma

30% of children have wheezing during respiratory infections before their third birthday. Why?

Infants are prone to wheeze because of:

- anatomic factors related to the lung and chest wall
- viral infections that lead to wheezing


Wheezing in Children - Phenotypes (click to enlarge the image).

Not every wheeze is indicative of asthma but prediction of asthma in persistent wheezers is possible. Testing for allergy in these infants is worthwhile and can be of significant value in avoidable allergens.


Childhood asthma phenotypes (click to enlarge the image).


Modified Asthma Predictive Index (mAPI) (click to enlarge the image).

A positive mAPI greatly increased future asthma probability (eg, 30% pretest probability to 90% posttest probability) http://buff.ly/ZJfMgQ

Treatment of an infant with wheezing depends on the underlying etiology. Response to bronchodilators is not easy to predict.

A trial of inhaled steroid may be warranted in a patient who has:

- responded to courses of oral steroids
- moderate to severe wheezing
- a significant history of atopy including food allergy or eczema

Ribavirin administered by aerosol, hyper-immune respiratory syncytial virus immunoglobulin (RSV IVIG), and intramuscular monoclonal antibody to an RSV protein have been used for RSV bronchiolitis in infants with congenital heart disease or chronic lung disease.

References:

Wheezing in infancy. El-Gamal, Yehia M. MD, PhD; El-Sayed, Shereen S. MD, PhD. World Allergy Organization Journal: May 2011 - Volume 4 - Issue 5 - pp 85-90, doi: 10.1097/WOX.0b013e318216b41f

Treatment of Pediatric Asthma