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n CME : Your SA Journal of CPD - Asthma assesment, diagnosis and management in young children : main article
- In a young child, not all wheezing is asthma.
- Children under the age of 5 need a different approach to the diagnosis and management of asthma to that in adults and older children.
- Transient (limited to a few months or years) wheezing in infancy is more likely to be a function of small airways, and wheezing in the first year of life does not persist as asthma in two-thirds of those afflicted.
- The differential diagnosis of wheezing in a young child includes: gastro-oesophageal reflux, cystic fibrosis, aspiration, immune deficiency, TB, bronchopulmonary dysplasia.
- A clue to the origin of wheeziness in children in South Africa may be failure to thrive or poor weight gain.
- Other history and examination clues are found in the markers of specific diseases, such as stigmata of AIDS, tuberculosis, congenital cardiac disease, cystic fibrosis and gastro-oesophageal reflux.
- It is as important to treat inflammation in the persistent chronic young asthmatic as it is in the older child and adult; however, some special situations exist.
- Viruses play an integral role in early childhood asthma and there is marked interplay between allergy / atopy and viral infections.
- There is mounting evidence from 3 studies that treating asthma in young children with leukotriene receptor antagonists at the time of a viral-induced asthma exacerbation is useful.
- The decision on how to treat a child depends on his / her current level of control, current impairment and individual risk factors.
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