Common steroid medications for children
with viral-induced wheezing proves ineffective

Wheezing, asthma require

an individulized approach

Although the initial conclusion from this research is that the commonly prescribed medications for young children who wheeze with viral infections are ineffective, the studies failed to address how children with less severe symptoms may respond to treatment. Also unclear was the potential for other side effects from very high doses of inhaled corticosteroids, particularly when used repeatedly since children may have six or more colds in a year.

Wheezing is a common problem in young children. It has been estimated that one in three children has at least one episode of wheezing by age three years. When their child wheezes, parents want to know if it means that their child has asthma.

This same question has been of major interest to physicians and researchers because currently there is no one test that determines whether a child has asthma or not. Therefore, the diagnosis is made based on clinical information, i.e., the child’s medical history, wheezing triggers, when and where it occurs, and to what treatments the child responds. This medical history is coupled with the child’s family history, such as whether there are other family members who have asthma or allergies, or other chronic breathing problems. Doctors also conduct a physical examination to provide further insight if, for example, there is evidence of allergic nasal symptoms or eczema.

Using this clinical information, researchers have recently found that the risk of asthma is about 60 percent for a child less than three years of age who has wheezed up to three times. For the remaining 40 percent of preschool children who have wheezed, the risk for having asthma is unclear.

Not all patients with asthma respond to asthma medications to the same degree. While some individuals’ asthma symptoms are well controlled with inhaled corticosteroids, others may require one or more different types of medications. Similarly, not all young children who wheeze will respond in the same way to asthma treatments. In fact, there have been several studies that have shown that children who develop bronchiolitis in the winter — a condition that causes wheezing — do not generally respond to standard asthma therapies. With many children who wheeze, the wheezing condition resolves as they grow older and they do not go on to develop asthma.

I recommend that parents of young children who wheeze whenever they have a viral infection (a cold) consult with their pediatrician to determine the best plan of action for their child.

Research continues to determine the optimal medication and regimen to treat wheezing in this age group. At the Yale Pediatric Asthma Program, pediatric pulmonologists provide comprehensive care for children with wheezing and/or asthma from infancy through adolescence. The program includes evaluation, diagnosis and management for patients with all degrees of asthma severity, and addresses the psychosocial impact of the disease on patient and family dynamics. Certified asthma nurse educators provide personalized education around triggers, self-management, administration of inhaled medications and care of equipment.

Dr. Bazzy-Asaad is the chief of respiratory medicine at Yale-New Haven Children’s Hospital and Yale School of Medicine and director of the Yale Pediatric Asthma Program.