Güncel Pediatri (Dec 2012)
Current Approach to Treatment and Follow-Up of Pre-School Children with Wheezing
Abstract
Exacerbations of wheezing or airway hyperreactivity in early years of life might be the first sign of developing asthma. Therefore, management of these children is important. The first and the most important step of the management is the primary prevention against asthma with education of the patient and his caregivers. In acute exacerbation of wheezing the most preferred treatment should be β2-agonists for both of the episodic and multi-trigger wheezing. Bronchodilators provide symptomatic relief in acute wheezy episodes but the evidence for oral steroid usage is contraversial for children. Parent initiated oral steroid courses cannot be recommended. Although maintenance treatment with low to moderate continuous inhaled corticosteroids (ICS) in pure episodic (viral) wheeze is ineffective, it has beneficial effects in multi-trigger wheezing.High dose ICS used intermittently are effective in children with both of the wheezing types, but this is associated with short term effects on growth and cannot be recommended as a routine. Leucotrien receptor antagonists (LTRA) might be recommended as continuous treatment for children with multi-trigger wheezing. Antihistamines, ketotifen and cromolyns do not have a role in management of wheezing in children. (Journal of Current Pediatrics 2012; 10: 98-102)
