Quand et pourquoi instituer une corticothérapie inhalée chez le nourrisson siffleur

Abstract

Asthma in infants presents special clinical and progressive features that differentiate it clearly from forms coming on at a later age. Its inflammatory character, in the chronic and recurrent forms, leaves no doubt about this. The nature of this inflammation is specific, with a predominantly neutrophilic cellular component. A number of randomized, placebo-controlled studies have demonstrated the efficacy of inhaled corticosteroids in virus-induced and in the recurrent and chronic forms. Two drugs in particular, fluticasone and budesonide, have been studied recently. The general tolerance to inhaled corticosteroids is good, although there are individual differences that may warrant a search for the lowest effective dose. In case of chronic asthma, three-month minimum treatment duration appears to be necessary. It is not certain that long-term treatment will be able to modify the progression of the disease and prevent epithelial remodelling. In any case, after stopping the treatment, one can begin to see functional abnormalities, which emphasizes the need for long-term follow-up. There are no reliable predictive criteria that allow one to identify the infants at risk for chronic asthma. Nevertheless, a personal or family history of allergy, the severity of the initial viral episode, and the existence of allergic rhinitis are some of the elements to be taken into consideration.