A clinical approach to a wheezy infant

Abstract

Wheeze is a continuous high-pitched sound, with musical quality, emitting from the chest during expiration. A pragmatic clinical classification is episodic (viral) wheeze and multi-trigger wheeze. Diagnostic difficulties include other conditions that give rise to noisy breathing which could be misidentified as wheeze as well as other causes of wheeze in children. Most pre school children with wheeze do not need rigorous investigations. Primary prevention is not possible but avoidance of environmental tobacco smoke exposure should be strongly encouraged. High dose ICS used intermittently are effective in children with frequent episodes of moderately severe episodic (viral) wheeze or multi-trigger wheeze, but this associated with short term effects on growth and cannot be recommended as a routine. Maintenance treatment with low to moderate continuous ICS in pure episodic (viral) wheeze is ineffective while it does work in multi-trigger wheeze but dose not modify the natural history of the condition. Even if there is a successful trial a break in treatment should be given to see if the symptoms have resolved or continuous therapy is still required. Maintenance as well as intermittent Montelukast has a role in both episodic and multi-trigger wheeze.