The wheezy infant and toddler asthmatic - a primary care approach

Abstract

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.