Wheezing in Infants: Is It Asthma or Is It Transient?

Wheezing in infants is a significant concern for parents. Not only is their child indistress, but they worry about asthma.

"Wheezing and rattling may resolve with age, or it may not," said Bradley Chipps, MD, CapitalAllergy & Respiratory Disease Center, Sacramento, CA. "The key is figuring out which child has atransient problem, who has an infection, and who has asthma."

Persistent chest rattling could indicate asthma, he told the AAP National Conference &Exhibition on Monday. But it could also be gastrointestinal reflux disease, a mechanical airwayobstruction, cystic fibrosis, bronchomalacia/tracheomalacia, congestive heart failure, a foreignbody, subglottic stenosis, or other conditions.

Bronchoscopy can help in differential diagnosis, Dr. Chipps continued. About a quarter ofpatients have GERD. Another significant minority of children have persistent bacterial bronchitis,which can be diagnosed with bronchial lavage. Treatment is usually a three to four-week course ofantibiotics, typically augmentin.

Pediatricians should suspect asthma if wheezing continues for two weeks or longer, if the childcoughs at night with exertion, or if there is an existing allergy or a familial history of asthma.The asthma predictive index, or API, can help distinguish asthma from other conditions.

The API includes two major criteria, parental history of asthma and physician-diagnosed atopicdermatitis. There are also three minor criteria: allergic reaction to milk, eggs, or peanuts;wheezing that is unrelated to viral infection; and blood eosinophils greater than 4%.The finding of one major or two minor criteria indicates asthma. Any other finding indicates acondition that is likely to resolve by first grade.

"The API isn't perfect, but it allows you to respond to parent's questions," Dr. Chipps said.