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Amy is 13 months old and presented to the children's emergency department with a 5-week history of wheezing. Her parents explain that they have seen her general practitioner twice and attended the local walk-in centre three times over the last month. She has been prescribed antibiotics and salbutamol both of which Amy ‘hates’. On examination, she had a dry cough with mild respiratory distress. She has occasional crepitations and widespread wheeze. Parents smoke ‘outside the house’ but neither has asthma. She is their first child. Clinically, she is well but parents would like to know whether inhalers will help.
Birth cohort studies have demonstrated that approximately one-third of the children aged between 1 and 5 years suffer recurrent episodes of respiratory symptoms including wheeze. Wheezing prevalence in UK children has increased from twofold to threefold during the past 40 years but may have stabilised or even peaked in the early 1990s. Fortunately, a majority of young children with wheeze tend to have only transient symptoms and do not have subsequently increased risk of asthma or allergy in later life. Nevertheless, childhood wheeze presents a major burden of morbidity during preschool years and there is significant progression from some childhood wheeze to adult asthma. More than 25% of an unselected birth cohort of children had wheezing that persisted from childhood into adulthood or that relapsed after remission. Despite the relative commonness of childhood wheeze, controversy and confusion exist over which treatments are effective. Doctors and nurses caring for these children face a dilemma regarding the treatment. Although bronchodilators are of clear benefit in older children with asthma, the anatomy and physiology in younger children are significantly different. In this article, we review the known physiology, the current evidence base and offer practical advice for those with a wheezy infant.
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