Transcript Wheezing in Young Children

Wheezing in Young
Children
Is it Bronchiolitis or is it
Asthma???
Bronchiolitis
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Bronchiolitis is an infectious, self-limited disease.
Its therapy is based on supportive care,
oxygenation, hydration, and fever control.
The pathology results in obstruction of
bronchioles from inflammation, edema, and
debris, leading to hyperinflation, increased airway
resistance, atelectasis, and ventilation-perfusion
mismatching (decreased O2 saturations)
Bronchoconstriction has not been described.
Bronchiolitis
Despite the prominent role that
inflammation plays in the pathogenesis of
airway obstruction, corticosteroids have
not proven beneficial in improving clinical
status in several large, controlled multiinstitutional studies.
 American Academy of Pediatrics Diagnosis and Management of
Bronchiolitis
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Asthma Predictive Index (API)
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Developed from a large longitudinal study from
the Tuscon Children’s Respiratory Study which
identified 3 groups of children who wheeze:
» Early wheezers
» Late onset wheezers
» Persistent wheezers
– API developed to differentiate “Early wheezers” from
“Persistent wheezers” or children who will develop
asthma
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API is the basis for the NHLBI recommendations
for Initiating Long-term Controller Therapy in
Young Children (0-4 years)
The Asthma Predictive Index: a very useful tool for predicting asthma in young
children.Source:Journal of allergy and clinical immunology [0091-6749] Castro
Rodriguez, Jose yr:2010 vol:126
NHLBI Guidelines for Initiating Long-term
Controller Therapy in Young Children (0-4
years)
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To reduce impairment in children who have:
– 1) 4 or more episodes of wheezing in the past year
» Wheezing lasted more than 1 day
» Affected sleep
» Risk factors for the development of asthma
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1 of the following:
– Parental history of asthma OR
– Physician diagnosed atopic dermatitis
– Evidence of sensitization to aeroallergens
OR 2 of the following:
– Evidence of food allergy
– Wheezing apart from colds
– Peripheral blood eosinophilia (> 4%)
Initiating Long-term Controller Therapy in
Young Children (0-4 years)
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To reduce impairment in children who
have:
2) Consistently required symptomatic treatment
(reliever) more than 2 times/week for greater
than 4 weeks
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Should be considered for reducing risk in
infants and young children who have 2
exacerbations requiring systemic steroids
within 6 months
Asthma Therapy in Children 0-4
Years
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Treatment is often in the form of a
therapeutic trial
– Monitor response over 4-6 weeks
» If no response, stop therapy and reevaluate for other
diagnosis
» If a clear positive response for at least 3 months
(good asthma control) step down as tolerated