[Infancy asthma: diagnostic and therapeutic approach]

ABSTRACT

Asthma in infants is characterized by recurrence of three episodes of dyspnea and wheezing within two first years of age. Asthma in infancy is a heterogeneous condition with different clinical phenotypes and outcome. So, the diagnostic and therapeutic approach are often difficult. The aim of this systematic review was to provide answers to the following questions in the management of recurrent wheeze in infants is it asthma?, should we treat wheezy infants?, what are the modalities of prescriptions ? what is the long term outcome of wheezy infants? Electronic literature search was performed in Medline. Key-words used for the final search were "infant", "wheezing", "atopy", "asthma", "inhaled corticosteroids". We considered for analysis meta analysis, randomized controlled trials, systematic reviews, cohort studies and consensus statement reports. The diagnosis of asthma in infants is more difficult than in older children or adults since many causes of "wheezing" may simulate an asthma associated to difficulties to evaluate bronchial hyper responsiveness in this age. There are three groups of wheezy infants transient early wheezers, persistent non atopic wheezers and persistent atopic wheezers or asthmatic .Since recent data have proved early bronchial inflammation in wheezy infants, inhaled corticosteroids have become the main treatment. However, management of asthmatic infants is more difficult according to anatomic and functional respiratory peculiarities. There is no reliable clinical or biological indicators of future asthma. The evidence of atopy in infants with recurrent wheezing seems to be the main risk factor of the development of persistent asthman