[Beta 2 agonists in infants and young children with a wheeze: often ineffective]

Wheezing is a common symptom in infants and young children, for which the treatment of choice is beta 2-agonists. However, the efficacy of beta 2-agonists in children aged 2 years and younger is not evidence based. Approximately 60% of wheezy infants do not have asthma, but a transient condition related to airway obstruction that is associated with coughing, wheezing and/or stuffiness: so-called infant asthma. In infants, beta 2-agonists may make the airways more compliant, resulting in more severe airway obstruction. In addition to this, beta 2-agonists increase the metabolism and cause ventilation-perfusion mismatch in the lung which may lead to a decrease in the oxygen saturation. Since it is unclear which infants will benefit from beta 2-agonists, a trial treatment is justified and this should be critically evaluated. Beneficial clinical effects of beta 2-agonists are a reduction in breathing frequency, reduction in or disappearance of retractions or the use of accessory respiratory muscles during breathing and possibly an increase in oxygen saturation. beta 2-agonists are effective and safe for the treatment of asthma. However, there is no basis for continuing the treatment in the case of infants and young children with an airway obstruction unless there is a clinically favourable effect.