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Wheezing in Young Children

Wheezing in Young Children. Is it Bronchiolitis or is it Asthma???. Bronchiolitis. Bronchiolitis is an infectious, self-limited disease. Its therapy is based on supportive care, oxygenation, hydration, and fever control.

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Wheezing in Young Children

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  1. Wheezing in Young Children Is it Bronchiolitis or is it Asthma???

  2. Bronchiolitis • 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.

  3. 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 multi-institutional studies. • American Academy of Pediatrics - Diagnosis and Management of Bronchiolitis

  4. Asthma Predictive Index (API) • 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 • 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

  5. NHLBI Guidelines for Initiating Long-term Controller Therapy in Young Children (0-4 years) • 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 • 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%)

  6. Initiating Long-term Controller Therapy in Young Children (0-4 years) • To reduce impairment in children who have: 2) Consistently required symptomatic treatment (reliever) more than 2 times/week for greater than 4 weeks • Should be considered for reducing risk in infants and young children who have 2 exacerbations requiring systemic steroids within 6 months

  7. Asthma Therapy in Children 0-4 Years • 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

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