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Asthma: diagnosis and management in the very young child
1Royal Alexandra Hospital for Children, Camperdown, New South Wales.
Insights
Most wheezy infants outgrow their condition. A small group develops troublesome asthma and requires inhaled medications. Congenital malformations must be ruled out before asthma treatment.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Management
Background:
- Wheezing in infants is common, with most cases resolving spontaneously in early childhood.
- A subset of infants experiences persistent, severe asthma symptoms, leading to significant morbidity and hospitalizations.
- Identifying underlying congenital anomalies is crucial before initiating asthma management.
Purpose of the Study:
- To outline the appropriate management of wheezing infants, differentiating between benign and persistent asthma.
- To emphasize the role of inhaled asthma medications and alternative delivery devices.
- To highlight the importance of excluding congenital malformations.
Main Methods:
- Review of current clinical guidelines and literature on infant wheezing and asthma.
- Discussion of diagnostic considerations, including the exclusion of congenital conditions.
- Evaluation of therapeutic options, focusing on inhaled corticosteroids and bronchodilators.
Main Results:
- Most infants with wheezing do not have serious underlying pathology and improve naturally.
- A proportion of infants develop significant asthma requiring inhaled pharmacotherapy.
- Metered-dose inhalers with spacers and face masks are effective alternatives to home nebulizers.
Conclusions:
- Wheezing infants require careful assessment to distinguish between transient symptoms and true asthma.
- Appropriate inhaled asthma medications should be considered for infants with persistent symptoms.
- Congenital malformations must be ruled out prior to commencing asthma drug therapy.
Abstract:
Most wheezy infants do not have a significant medical problem, and most will outgrow the condition in early childhood. A small proportion, however, have troublesome asthma and suffer significant morbidity (such as severe episodes of breathlessness and persistent distressing cough, and are often admitted to hospital). These infants should be offered appropriate asthma medications by inhalation (Table 4) to which most will respond. Although many currently use home nebulisers, alternative inhalation devices (especially the MDI/spacer/face mask) should be encouraged. A few wheezy infants will have a major underlying congenital malformation. Ruling out this group of conditions is essential before embarking on any asthma drug therapy.