Among young children who wheeze, which children will have persistent asthma?

摘要

We are frequently faced with answering questions regarding the persistence of asthma and which children will outgrow the disease. Consider 2 similar children you might see during the same clinic session. Patient 1 is a 2-year-old boy who presents with a history of wheezing episodes with each upper respiratory tract infection during the previous fall and winter. He has needed aggressive use of bronchodilators and prednisone courses 3 times over the last 6 months. It is not clear whether he wheezes between colds, but his parents notice some coughing when he is upset and crying. He has had mild eczema since infancy, severe skin test reactivity to peanut (which he has never ingested), and parental history of asthma and seasonal rhinitis. Patient 2 is somewhat similar with a normal first year of life and the same sort of difficulty, with apparent viral syndromes precipitating worrisome wheezing exacerbations several times in the past fall and winter. This child has no history of atopic rash or food sensitiza-tion, and his parents have never had allergic problems or asthma. What risk factors do these children have in terms of future asthma persistence and severity, likelihood of remission of bronchial reactivity, and residual lung function deficits? What treatment approaches would lead to the best outcome for these 2 children?