Diagnosing and treating chesty infants

A short trial of inhaled corticosteroid is probably the best approach

Recurrent cough and wheeze in infancy are common problems in general practice and paediatric outpatient clinics. Population based research indicates that only a minority of such infants have asthma. 1 2 For example, data from the 1970 British cohort study showed that only 23% of infants who had had four or more attacks of wheezing in the first year of life had evidence of asthma at the age of 10. Studies over the past decade have provided a better understanding of the factors that lead to these symptoms in infants who have asthma and those who do not, at least in parts of the world with a Western lifestyle.

The intrathoracic airways of infants are vulnerable to obstruction because of their narrow calibre, and those infants who are born with the narrowest airways seem to be prone to lower respiratory tract illness during viral infections.3 The airways of most infants with recurrent wheeze are not characterised by the bronchial hyperresponsiveness4 typical …