Infantile wheeze: rethinking dogma

Abstract

Wheeze is a common symptom in young children and is usually associated with viral illnesses. It is a major source of morbidity and is responsible for a high consumption of healthcare and economic resources worldwide. A few children have a condition resembling classical asthma. Rarer specific conditions may have a wheezy component and should be considered in the differential diagnosis. Over the last half century, there have been many circular discussions about the best way of managing preschool wheeze. In general, intermittent wheezing should be treated with intermittent bronchodilator therapy, and a controller therapy should be prescribed for a young child with recurrent wheezing only if positively indicated, and only then if carefully monitored for efficacy. Good multidisciplinary support, attention to environmental exposition and education are essential in managing this common condition. This article analyses the pathophysiological basis of wheezing in infancy and critically discusses the evolution of the scientific progress over time in this unique field of respiratory medicine.

Human Milk and Allergic Diseases: An Unsolved Puzzle

“…Some of the differences can be explained by variations in the definitions for breastfeeding exclusivity and duration, and methods to diagnose asthma in children [ 87 ]. It is known that many infants who wheeze in the first years of life do not develop asthma in later life [ 88 ], but wheeze is often used as the diagnostic marker of asthma. There are several notable large prospective birth cohorts, such as Avon Longitudinal Study of Parents and Children (ALSPAC) [ 50 ], Prevention and Incidence of Asthma and Mite Allergy (PIAMA) [ 89 ] and the cross-sectional International Study of Asthma and Allergies in Childhood (ISAAC) [ 90 ] study, with data from these studies considered of higher quality [ 75 ].…”

Breastfeeding and the Developmental Origins of Asthma: Current Evidence, Possible Mechanisms, and Future Research Priorities

“…Many studies do not measure lung function and must rely on parent-reported or self-reported asthma symptoms or medication use. This is problematic because wheezing is often used as the diagnostic marker of asthma, yet wheezing can be caused by infections that are unrelated to asthma, and not all infants or children who wheeze proceed to develop asthma [ 41 ]. In addition, different asthma phenotypes exist, such as atopic or non-atopic asthma, and early- or late-onset asthma [ 42 , 43 ].…”

Transforming growth factor beta in human milk and allergic outcomes in children: A systematic review

“…It has been demonstrated that many “early wheezers” do not subsequently develop persistent asthma . There may even be an inverse relationship between early infection‐induced wheeze and subsequent asthma . It should be noted that most of the studies assessing asthma included in this systematic review were realistically measuring wheeze rather than asthma, as age at health outcome assessment does not allow for appropriate asthma diagnosis.…”

“…42 There may even be an inverse relationship between early infection-induced wheeze and subsequent asthma. 67 It should be noted that most of the studies assessing asthma included in this systematic review were realistically measuring wheeze rather…”