Wheeze is common in infants and young children. Asthma is but one cause and it is obviously important to
exclude or include as it is amenable to specific therapy. It is also obvious that the pre-school or young child is not
just a smaller variety of the older child or adult and this is especially true of asthma, where special situations exist
with regard to diagnosis and treatment. Although there is a differential diagnosis for the major symptoms that
constitute asthma in this age group, no child should be left to wheeze or cough without the possibility of asthma
being considered and excluded. New guidelines and reports suggest that differentiation of virally induced wheeze
from multi-trigger wheeze (or toddler asthma) is less important than making an attempt to manage the child. If
an infant, or young child, has a chronic wheeze and is atopic or responds to a bronchodilator, asthma is more
likely and therapy should be tried. If, however, there is no response to the therapy, investigate for other causes.
Remember that in South Africa wheeze may also be produced by chronic infections, gastro-oesophageal reflux,
cardiac failure, cystic fibrosis and a host of other sinister conditions. Therapeutically, for mild and intermittent
wheeze the choice of inhaled corticosteroid (ICS) or a leukotriene antagonist may be valuable options. Therapy
is intermittent and should be started pre-emptively. However, for more severe and frequent symptoms regular
use of ICS (moderate dose) is clearly the best therapeutic option.