A cost-effective approach to the diagnosis and treatment of the wheezing infant

Abstract

Wheezing in infancy presents the clinician with at least two broad clinical problems. First is the task of distinguishing the common entities of bronchiolitis and asthma from rare, yet potentially life threatening illnesses that may present with wheezing. The second problem deals with the difficulties in distinguishing an infant with an isolated episode of wheezing with an upper respiratory tract infection from those infants who are at risk for persistence of wheezing through infancy. When confronted with a wheezing infant, a family may appropriately have the following questions: Is this asthma? What testing is needed? What risk for recurrence is present? A physician may focus similarly on the issue of risk of persistence of wheezing and be left with the difficult decisions of the cost and benefit of different diagnostic and therapeutic modalities. In order to best address these questions, a brief review of the pathophysiology, clinical, and epidemiological features associated with wheezing in infancy is offered.