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Inhaled Corticosteroids Should Be Used in Infants and Preschoolers with Recurrent Wheezing
1Department of Pediatrics, University of Louisville, Louisville, Kentucky.
Insights
Diagnosing and treating wheezing in infants is challenging due to varied presentations. Inhaled corticosteroids (ICS) are recommended for infants with multi-trigger wheeze or a positive asthma predictive index.
Area of Science:
- Pediatrics
- Pulmonology
- Allergy
Background:
- Persistent or recurrent wheezing in infants under two years presents diagnostic and therapeutic challenges.
- Lack of consistent definitions and recognition of distinct asthma phenotypes in young children complicates diagnosis.
- Limited clinical guidelines and ongoing controversy surround the use of inhaled corticosteroids (ICS) in infants.
Purpose of the Study:
- To review different phenotypic presentations of wheezing in infants.
- To clarify the role and indications for inhaled corticosteroids (ICS) in this age group.
- To propose a treatment plan for wheezing infants based on the etiology.
Main Methods:
- Literature review of wheezing disorders in infants.
- Analysis of current knowledge on asthma diagnosis and management in early childhood.
- Evaluation of the evidence for inhaled corticosteroid (ICS) use.
Main Results:
- Wheezing in infants is complex, with various phenotypes contributing to diagnostic uncertainty.
- Inhaled corticosteroids (ICS) appear indicated for infants experiencing multi-trigger wheeze or those with a positive asthma predictive index.
- Existing studies have offered insights into the natural history but have had limited impact on clinical management.
Conclusions:
- A clear understanding of infant wheezing phenotypes is crucial for effective management.
- Inhaled corticosteroids (ICS) should be considered for specific infant populations based on clinical indicators.
- A structured treatment approach, tailored to the cause of wheezing, is suggested for clinical practice.
Abstract:
The infant or child presenting to the physician's office with persistent or recurrent wheezing during the first 2 years of life poses, often times, a diagnostic dilemma, and a therapeutic challenge. Until very recently, no guidelines were present to help the clinician navigate the very limited treatment options. The diagnosis of asthma in the very young is primarily difficult because of the lack of consistency of what is called asthma, and the failure to recognize the different phenotypes of asthma at different ages. Many classification and phenotypic descriptions have been proposed, but they continue to cause more confusion to already confused parents and perplexed physicians. Although these studies have provided much insight into the natural history of wheezy disorders, they have failed to affect clinical management to a large extent. Controversy persists as to when and why and how long inhaled corticosteroids (ICS) should be used in wheezy infants. Based on the current knowledge in this age group, ICS seems to be indicated in infants with multi-triggers wheeze, and in infants with a positive asthma predictive index. This article reviews the different phenotypic presentations of wheezy infant, the role and indications of ICS in this situation, and, finally, suggests a treatment plan based on the apparent cause of wheezing.
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