Wheezing And Asthma In Infants And Young Children

A child coughing and Weezing from Asthma

Wheezing is a relatively high-pitched whistling sound, which is generated by the movement of air through constricted or compressed small airways. It comes in the first years of life are common and is usually caused by a viral respiratory infection or asthma, but other possible causes include inhaled irritants or allergens, reflux, and heart failure.

Recurrent episodes of wheezing are common in the early years; 1 of 3 children has at least one acute Keuchperiode of 3 years before the age (1). As such, wheezing typically responds to bronchodilators, this problem was considered historically as asthma. Recent evidence that many children who have had recurrent wheezing in early childhood and later in childhood or adolescence have no asthma, however, suggests that alternative diagnoses in children should be considered with recurrent wheezing.

Wheezing is a relatively high-pitched whistling sound, which is generated by the movement of air through constricted or compressed small airways. It comes in the first years of life are common and is usually caused by a viral respiratory infection or asthma, but other possible causes include inhaled irritants or allergens, reflux, and heart failure. Recurrent episodes of wheezing are common in the early years; 1 of 3 children has at least one acute Keuchperiode of 3 years before the age (1). As such, wheezing typically responds to bronchodilators, this problem was considered historically as asthma.

Recent evidence that many children who have had recurrent wheezing in early childhood and later in childhood or adolescence have no asthma, however, suggests that alternative diagnoses in children should be considered with recurrent wheezing. Tips and risks Not every wheezing in infants and young children is asthma. General note 1. Taussig LM, Wright AL, Holberg CJ, et al: Tucson Children’s Respiratory Study: 1980 to present. J Allergy Clin Immunol 111: 661-675, 2003. Etiology Some infants have recurrent episodes of wheezing, the first manifestations of asthma and these children will continue to wheeze later in childhood or adolescence.

For other children, the episodes of wheezing stop until the age of 6 to 10 years and it is not expected to pose asthma. In infants and toddlers is wheezing with viral illnesses, especially those caused by respiratory syncytial virus and human rhinovirus, associated with an increased risk of developing asthma in children (2). A subsequent diagnosis of asthma in children who have atopic symptoms, severe episodes of wheezing and / or a family history of atopy or asthma, more likely. Wheezing usually results from bronchospasm, which may be degraded caused by inflammation of the small and medium-sized airways edema and a further narrowing of the airways.

An acute episode of wheezing in infants and young children is usually caused by viral respiratory infections, but airway inflammation may also be caused by allergies or inhaled irritants (eg. As tobacco smoke) caused (or worsened). Recurrent wheezing can be caused by frequent viral respiratory infections, allergies or asthma. Among the less common causes recurrent wheezing chronic dysphagia, recurrent aspiration are causes gastroesophageal reflux, Atemwegsmalacia, a retained foreign object sucked or heart failure. Often the cause recurrent wheezing is unclear. Note on etiology first Sigurs N, R Bjarnason, Sigurbergsson F, et al: Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7. Am J Respir Crit Care Med161: 1501-1507, 2000. doi : 10.1164 / ajrccm.161.5.9906076. Symptoms and complaints wheezing is often accompanied by recurrent dry or productive cough.

Symptoms

Other symptoms depend on the etiology, and may include fever, runny nose (viral infection) and feeding difficulties (eg. As a result of heart failure or dysphagia) include. On examination, wheezing manifested mainly in the aspiration, unless the airway narrowing is severe, if wheezing is heard during inspiration. Other findings that are present with more severe disease may include tachypnea nostrils, intercostal and / or Subxiphoideinziehungen and cyanosis. Children with respiratory infections may have fever. Diagnostic chest X-ray in severe first episode and sometimes atypical or recurrent episodes In a first episode of heavy panting most doctors perform a chest x-ray through to detect signs of sucked foreign body pneumonia or heart failure, and a pulse oximeter to meet the need to assess a Sauerstoffherapie.

The presence of general hyperinflation on plain radiographs sets diffused air trapping close as in asthma, while suggesting localized results on structural abnormalities or foreign body. Chest X-ray may be also the presence of a vascular ring as a cause of wheezing show (z. B. right aortic arch). In children with recurrent episodes of deterioration do not require testing in general, unless signs of respiratory distress are present.

Testing

Testing such as swallowing studies Kontrastösophagogramm, CT or bronchoscopy may possibly be helpful in the few children with frequent or severe deterioration or symptoms that do not respond to bronchodilators or other asthma medication. Prognosis Many children with recurrent wheezing in early childhood will have no clinically relevant wheezing later in life. Many older children and adults with chronic asthma difficult, however, developed the symptoms already in early childhood. Therapy for acute episodes of wheezing, inhaled bronchodilators and, if appropriate, systemic corticosteroids in children with frequent severe episodes of wheezing, an attempt of maintenance therapy (eg. As inhaled corticosteroids) such as in asthma infants and young children with acute wheezing received inhaled bronchodilators and provided that the panting is severe, systemic corticosteroids (s. treatment of acute exacerbation).

Children who will probably not develop persistent asthma, such as those who have no atopy or a family history of atopy or asthma, and their episodes of wheezing are relatively light and rarely can be usually treated with inserted only when needed inhaled bronchodilator , Most toddlers with frequent and / or severe episodes of wheezing benefit from maintenance therapy with bronchodilators and anti-inflammatory drugs (such as inhaled corticosteroids.) As used in asthma (asthma: Treatment). Although the chronic use of a leukotriene modifier or low-dose inhaled corticosteroids reduces the severity and frequency of episodes of wheezing, it does not alter the natural course of the disease.

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