Wheezing in Young Children Is it Bronchiolitis or is it

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 Childrens 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.SourceJou
rnal of allergy and clinical immunology
0091-6749 Castro Rodriguez, Jose yr2010 vol126
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 (gt 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