The Wheezing Infant and Young Child

  • Peter J. Helms
Part of the Allergy Frontiers book series (ALLERGY, volume 5)

Although the notion that childhood wheezing illnesses, particularly those presenting in infancy and early childhood (children less than 5 yrs), may have different causes is not new, studies in recent years have revealed and rediscovered a number of distinct wheezing conditions in this early phase of life [1] (Table 1). The highest prevalence of recurrent wheezing is found in the first years of life and according to long-term population-related prospective birth cohort studies, up to 50% of all infants and children below the age of 3 years will have at least one such episode [2]. Wheezing in this early period of life is often transient, and 60% of children with mild intermittent infantile wheeze will become asymptomatic in later childhood [3].

On the other hand infants with more severe recurrent wheezing have a higher risk of developing persistent asthma particularly if they are also atopic [4]. However, both the incidence and period prevalence of wheezing decreases significantly with increasing child age [5].


Respiratory Syncytial Virus Allergy Clin Immunol Respir Crit Respiratory Syncytial Virus Infection Airway Remodel 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Landau LI (2008) Wheezing phenotypes. Thorax 63:942–943.CrossRefPubMedGoogle Scholar
  2. 2.
    Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ (1995) Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 332:133–138.Google Scholar
  3. 3.
    Morgan WJ, Stern DA, Sherrill DL, Guerra S, Holberg CJ, Guilbert TW et al (2005) Outcome of asthma and wheezing in the first 6 years of life: Follow-up through adolescence. Am J Respir Crit Care Med 172:1253–1258.CrossRefPubMedGoogle Scholar
  4. 4.
    Illi S, von ME, Lau S, Niggemann B, Gruber C, Wahn U (2006) Perennial allergen sensitisa-tion early in life and chronic asthma in children: A birth cohort study. Lancet 368:763–770.CrossRefPubMedGoogle Scholar
  5. 5.
    Taussig LM, Wright AL, Holberg CJ, Halonen M, Morgan WJ, Martinez FD (2003) Tucson Children's Respiratory Study: 1980 to present. J Allergy Clin Immunol 111:661–675.CrossRefPubMedGoogle Scholar
  6. 6.
    Chernick V and West J (2006) The functional basis of respiratory disease. In V. Chernick, T. Boat, R. Wilmott, and A. Bush, editors Kendig's disorders of the respiratory tract in children Saunders, Philadelphia. 29–64.Google Scholar
  7. 7.
    Elphick HE, Sherlock P, Foxall G, Simpson EJ, Shiell NA, Primhak RA, et al (2001) Survey of respiratory sounds in infants. Arch Dis Child 84:35–39.CrossRefPubMedGoogle Scholar
  8. 8.
    Cane RS, Ranganathan SC, McKenzie SA (2000) What do parents of wheezy children understand by “wheeze”?. Arch Dis Child 82:327–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Lowe L, Murray CS, Martin L, Deas J, Cashin E, Poletti G, et al (2004) Reported versus confirmed wheeze and lung function in early life. Arch Dis Child 89:540–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Saglani S, McKenzie SA, Bush A, Payne DN (2005) A video questionnaire identifies upper airway abnormalities in preschool children with reported wheeze. Arch Dis Child 90:961–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Stein RT, Holberg CJ, Morgan WJ, Wright AL, Lombardi E, Taussig L, et al (1997) Peak flow variability, methacholine responsiveness and atopy as markers for detecting different wheezing phenotypes in childhood. Thorax 52:946–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Turner SW, Palmer LJ, Rye PJ, Gibson NA, Judge PK, Cox M, et al (2004) The relationship between infant airway function, childhood airway responsiveness and asthma. Am J Respir Crit Care Med 169:921–927.CrossRefPubMedGoogle Scholar
  13. 13.
    Elphick HE, Ritson S, Everard ML (2002) Differential response of wheezes and ruttles to anticholinergics. Arch Dis Child 86:280–1.CrossRefPubMedGoogle Scholar
  14. 14.
    British guideline on the management of asthma (2008) Thorax 63(Suppl 4):1–121.Google Scholar
  15. 15.
    Anderson HR, Pottier AC, Strachan DP (1992) Asthma from birth to age 23: Incidence and relation to prior and concurrent atopic disease. Thorax 47:537–542.CrossRefPubMedGoogle Scholar
  16. 16.
    Boesen I. Asthmatic bronchitis in children (1953) Prognosis for 162 cases, observed 6–11 years. Acta Paediatrica 42:87–96.CrossRefPubMedGoogle Scholar
  17. 17.
    Tager IB, Hanrahan JP, Tosteson TD, Castile RG, Brown RW, Weiss ST, et al (1993) Lung function, pre- and post-natal smoke exposure and wheezing in the first year of life. Am Rev Resp Dis 147:811–817.PubMedGoogle Scholar
  18. 18.
    Wang X, Wypij, D, Gold DR, Speizer FE, Ware JH, Ferris BG, et al (1994) A longitudinal study of the effects of parental smoking on pulmonary function in children 6–18 years. Am J Respir Crit Care Med 149:1420–1425.PubMedGoogle Scholar
  19. 19.
    Chan KN, Elliman A, Bryan E, Silverman M (1989) Respiratory symptoms in children of low birth weight. Arch Dis Child 64:1294–1304.CrossRefPubMedGoogle Scholar
  20. 20.
    Chan KN, Noble-Jamieson CM, Elliman A, Bryan EM, Silverman M (1989) Lung function in children of low birth weight. Arch Dis Child 64:1284–1293.CrossRefPubMedGoogle Scholar
  21. 21.
    von Mutius E, Nicolai T, Martinez FD (1993) Prematurity as a risk factor for asthma in preadolescent children. J Pediatr 123:223–229.CrossRefGoogle Scholar
  22. 22.
    Murray M, Webb MS, O'Callaghan C, Swarbrick AS, Miiner AD (1992) Respiratory status and allergy after bronchiolitis. Arch Dis Child 67:482–487.CrossRefPubMedGoogle Scholar
  23. 23.
    Sigurs N, Gustafsson PM, Bjarnason R, Lundberg F, Schmidt S, Sigurbergsson F et al (2005) Severe respiratory syncytial virus bronchiolitis in infancy and asthma and allergy at age 13. Am J Respir Crit Care Med 171:137–41.CrossRefPubMedGoogle Scholar
  24. 24.
    Stein RT, Sherrill D, Morgan WJ, Holberg CJ, Halonen M, Taussig LM, et al (1999) Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 354:541–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Strachan D, Gerritsen J (1996) Long-term outcome of early childhood wheezing: Population data. Eur Resp J 9:42S–47S.CrossRefGoogle Scholar
  26. 26.
    Martin AJ, Landau LI, Phelan PD (1981) Natural history of allergy in asthmatic children followed to adult life. Med J Aust 2:470–474.PubMedGoogle Scholar
  27. 27.
    Kelly WJ, Hudson I, Phelan PD, Pain MC, Olinsky A (1990) Atopy in subjects with asthma followed to the age of 28 years. J Allergy Clin Immunol 85:548–557.CrossRefPubMedGoogle Scholar
  28. 28.
    Sibbald B, Horn ME, Gregg I (1980) A family study of the genetic basis of asthma and wheezy bronchitis. Arch Dis Child 55:354–357.CrossRefPubMedGoogle Scholar
  29. 29.
    Jenkins MA, Hopper JL, Bowes G, Carlin JB, Flander LB, Giles GG (1994) Factors in childhood as predictors of asthma in adult life. Brit Med J 309:90–93.PubMedGoogle Scholar
  30. 30.
    Renes S, Korppi M, Renes K, Savolainen K, Monoren I, Pekkaren J (1998) Serum eosinophil cationic protein (ECP) and eosinophil protein X (EPX) in childhood asthma. Pediatr Pulmonol 25:167–174.CrossRefGoogle Scholar
  31. 31.
    Sporik R, Holgate ST, Cogswell JJ (1991) Natural history of asthma in childhood - a birth cohort study. Arch Dis Child 66:1050–1053.CrossRefPubMedGoogle Scholar
  32. 32.
    Brooke AM, Lambert PC, Burton PR, Clarke C, Luyt DK, Simpson H (1995) The natural history of respiratory symptoms in preschool children. Am J Resp Crit Care Med 152:1872–1878.PubMedGoogle Scholar
  33. 33.
    Pattemore PK, Asher MI, Harrison AC, Mitchell EA, Rea HH, Stewart AW (1990) The interrelationship among bronchial hyperresponsiveness, the diagnosis of asthma, and asthma symptoms. Am Rev Respir Dis 142:549–554.PubMedGoogle Scholar
  34. 34.
    Peat JK, Britton WJ, Salome CM, Woolcock AJ (1987) Bronchial hyperresponsiveness in two populations of Australian schoolchildren. II. Relative importance of associated factors. Clin Allergy 17:283–290.CrossRefPubMedGoogle Scholar
  35. 35.
    Horn MEC, Brain EA, Gregg I, Inglis JM, Yealland SJ, Taylor P (1979) Respiratory viral infection and wheezy bronchitis in childhood. Thorax 34:23–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Taussig LM, Smith SM, Blumenfeld R (1981) Chronic bronchitis in childhood: What is it? Pediatrics 67:1–5.PubMedGoogle Scholar
  37. 37.
    Speight ANP, Lee DA, Hey EN (1983) Underdiagnosis and undertreatment of asthma in childhood. Br Med J 286:1253–1256.CrossRefGoogle Scholar
  38. 38.
    Williams H, McNicol KN (1969) Prevalence,natural history,and relationship of wheezy bronchitis and asthma in children. An Epidemiological study. Br Med J 4:321–325.Google Scholar
  39. 39.
    Stevenson EC, Turner G, Heaney LG, Schock BC, Taylor R, Gallagher T, Ennis M, Shields MD (1997) Bronchoalveolar lavage findings suggest two different forms of childhood asthma. Clin Exp Allergy 27:1027–1035.CrossRefPubMedGoogle Scholar
  40. 40.
    Wilson NM (1989) Wheezy bronchitis revisited. Arch Dis Child 64:1194–1199.CrossRefPubMedGoogle Scholar
  41. 41.
    Clifford RD, Howell JB, Radford M, Holgate ST (1989) Associations between respiratory symptoms, bronchial response to methacholine, and atopy in two age groups of schoolchildren. Arch Dis Child 64:1133–1139.CrossRefPubMedGoogle Scholar
  42. 42.
    Anonymous (1988) Cough and Wheeze in Asthma: Are they Interdependent? Lancet 447–448.Google Scholar
  43. 43.
    Hannaway PJ, Hopper GDK (1982) Cough variant asthma in children. JAMA 247:206–208.CrossRefPubMedGoogle Scholar
  44. 44.
    Corrao WM, Braman SS, Irwin RS (1979) Chronic cough as the sole presenting manifestation of bronchial asthma. N Engl J Med 300:633–637.PubMedGoogle Scholar
  45. 45.
    McKenzie S (1994) Cough – but is it asthma? Arch Dis Child 70:1–2.CrossRefPubMedGoogle Scholar
  46. 46.
    Fitch PS, Brown V, Schock BC, Taylor R, Ennis M, Shields MD (2000) Chronic cough in children: Bronchoalveolar lavage findings. Eur Respir J 16:1109–14.CrossRefPubMedGoogle Scholar
  47. 47.
    Gibson PG, Simpson JL, Chalmers AC, Toneguzzi RC, Wark PA, Wilson AJ et al (2001) Airway eosinophilia is associated with wheeze but is uncommon in children with persistent cough and frequent chest colds. Am J Respir Crit Care Med 164:977–81.PubMedGoogle Scholar
  48. 48.
    Duffy DL, Mitchell CA (1993) Lower respiratory tract symptoms in Queensland schoolchildren: Risk factors for wheeze, cough and diminished ventilatory function. Thorax 48:1021–1024.CrossRefPubMedGoogle Scholar
  49. 49.
    Strachan DP, Anderson HR, Bland JM, Peckham C (1988) Asthma as a link between chest illness in childhood and chronic cough and phlegm in young adults. Brit Med J 296:890–893.CrossRefGoogle Scholar
  50. 50.
    Shaheen SO, Barker DJ, Shiell AW, Crocker FJ, Wield GA, Holgate ST (1994) The relationship between pneumonia in early childhood and impaired lung function in late adult life. Am J Resp Crit Care Med 149:616–619.PubMedGoogle Scholar
  51. 51.
    Barker DJ, Godfrey KM, Fall C, Osmond C, Winter PD, Shaheen SO (1991) Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease. Brit Med J 303:671–675.CrossRefPubMedGoogle Scholar
  52. 52.
    Burrows B, Knudson RJ, Cline MG, Lebowitz MD (1988) A reexamination of risk factors for ventilatory impairment. Am Rev Respir Dis 138:829–836.PubMedGoogle Scholar
  53. 53.
    Chang AB, Phelan PD, Carlin JB, Sawyer SM, Robertson CF (1998) A randomised, placebo controlled trial of inhaled salbutamol and beclomethasone for recurrent cough. Arch Dis Child 79:6–11.CrossRefPubMedGoogle Scholar
  54. 54.
    Shields MD, Bush A, Everard ML, McKenzie S, Primhak R, on behalf of the British Thoracic Society Cough Guideline Group (2008) Thorax 63(Suppl 3):1–15.Google Scholar
  55. 55.
    Heymann PW, Carper HT, Murphy DD, Platts-Mills TA, Patrie J, McLaughlin AP et al (2004) Viral infections in relation to age, atopy, and season of admission among children hospitalized for wheezing. J Allergy Clin Immunol 114:239–247.CrossRefPubMedGoogle Scholar
  56. 56.
    Murray CS, Poletti G, Kebadze T, Morris J, Woodcock A, Johnston SL et al (2006) Study of modifiable risk factors for asthma exacerbations: Virus infection and allergen exposure increase the risk of asthma hospital admissions in children. Thorax 61:376–382.CrossRefPubMedGoogle Scholar
  57. 57.
    Sigurs N (2002) Clinical perspectives on the association between respiratory syncytial virus and reactive airway disease. Respir Res 3(Suppl 1):S8–14.CrossRefPubMedGoogle Scholar
  58. 58.
    Illi S, von ME, Lau S, Bergmann R, Niggemann B, Sommerfeld C et al (2001) Early childhood infectious diseases and the development of asthma up to school age: A birth cohort study. Brit Med J 322:390–395.CrossRefPubMedGoogle Scholar
  59. 59.
    Papadopoulos NG, Bates PJ, Bardin PG, Papi A, Leir SH, Fraenkel DJ et al (2000) Rhinoviruses infect the lower airways. J Infect Dis 181:1875–1884.CrossRefPubMedGoogle Scholar
  60. 60.
    Papadopoulos NG, Stanciu LA, Papi A, Holgate ST, Johnston SL (2002) A defective type 1 response to rhinovirus in atopic asthma. Thorax 57:328–332.CrossRefPubMedGoogle Scholar
  61. 61.
    Xepapadaki P, Papadopoulos NG, Bossios A, Manoussakis E, Manousakas T, Saxoni-Papageorgiou P (2005) Duration of postviral airway hyperresponsiveness in children with asthma: Effect of atopy. J Allergy Clin Immunol 116:299–304.CrossRefPubMedGoogle Scholar
  62. 62.
    Moshammer H, Hoek G, Luttmann-Gibson H, Neuberger MA, Antova T, Gehring U et al (2006) Parental smoking and lung function in children: An international study. Am J Respir Crit Care Med 173:1255–1263.CrossRefPubMedGoogle Scholar
  63. 63.
    Burrows B, Bloom JW, Traver GA, Cline MG (1987) The course and prognosis of different forms of chronic airways obstruction in a sample from the general population. N Engl J Med 317:1309–1314.PubMedGoogle Scholar
  64. 64.
    Halken S (2004) Prevention of allergic disease in childhood: Clinical and epidemiological aspects of primary and secondary allergy prevention. Pediatr Allergy Immunol 15(Suppl 16):4–32.PubMedGoogle Scholar
  65. 65.
    Bousquet J, Jeffery PK, Busse WW, Johnson M, Vignola AM (2000) Asthma. From broncho-constriction to airways inflammation and remodeling. Am J Respir Crit Care Med 161:1720–1745.PubMedGoogle Scholar
  66. 66.
    Pohunek P, Warner JO, Turzikova J, Kudrmann J, Roche WR (2005) Markers of eosinophilic inflammation and tissue re-modelling in children before clinically diagnosed bronchial asthma. Pediatr Allergy Immunol 16:43–51.CrossRefPubMedGoogle Scholar
  67. 67.
    Barbato A, Turato G, Baraldo S, Bazzan E, Calabrese F, Tura M et al (2003) Airway inflammation in childhood asthma. Am J Respir Crit Care Med 168:798–803.CrossRefPubMedGoogle Scholar
  68. 68.
    Payne DN, Rogers AV, Adelroth E, Bandi V, Guntupalli KK, Bush A et al (2003) Early thickening of the reticular basement membrane in children with difficult asthma. Am J Respir Crit Care Med 167:78–82.CrossRefPubMedGoogle Scholar
  69. 69.
    Saglani S, Malmstrom K, Pelkonen AS, Malmberg LP, Lindahl H, Kajosaari M et al (2005) Airway remodeling and inflammation in symptomatic infants with reversible airflow obstruction. Am J Respir Crit Care Med 171:722–727.CrossRefPubMedGoogle Scholar
  70. 70.
    Davies DE, Wicks J, Powell RM, Puddicombe SM, Holgate ST (2003) Airway remodeling in asthma: New insights. J Allergy Clin Immunol 111:215–225.CrossRefPubMedGoogle Scholar
  71. 71.
    Vignola AM, Gagliardo R, Siena A, Chiappara G, Bonsignore MR, Bousquet J et al (2001) Airway remodeling in the pathogenesis of asthma. Curr Allergy Asthma Rep 1:108–115.CrossRefPubMedGoogle Scholar
  72. 72.
    Guilbert TW, Morgan WJ, Zeiger RS, Mauger DT, Boehmer SJ, Szefler SJ et al (2006) Longterm inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med 354:1985–1997.CrossRefPubMedGoogle Scholar
  73. 73.
    Russell G, Helms PJ (1997) Reporting of common respiratory and atopic symptoms has increased. Brit Med J 315:1014–1015.PubMedGoogle Scholar
  74. 74.
    Christie GL, Helms PJ, Godden DJ et al (1999) Asthma, wheezy bronchitis and atopy across two generations. Am J Resp Crit Care Med 159:125–129.PubMedGoogle Scholar
  75. 75.
    Wahn U, Lau S, Bergmann R et al (1997) Indoor allergen exposure is a risk factor for sensi-tization during the first three years of life. J Allergy Clin Immunol 99:763–769.CrossRefPubMedGoogle Scholar
  76. 76.
    Brand PLP, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, et al (2008) Definition, assessment and treatment of wheezing disorders in preschool children: An evidence-based approach. Eur Respir J 32:1096–1110.CrossRefPubMedGoogle Scholar
  77. 77.
    Donahue JG, Weiss ST, Livingston JM, Goetsch MA, Greineder DK, Platt R (1997) Inhaled steroids and the risk of hospitalization for asthma. JAMA 277:887–891.CrossRefPubMedGoogle Scholar
  78. 78.
    Wennergren G, Kristjansson S, Strannegard IL (1996) Decrease in hospitalization for treatment of childhood asthma with increased use of antiinflammatory treatment, despite an increase in the prevalence of asthma. J Allergy Clin Immunol 97:742–748.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Peter J. Helms
    • 1
    • 2
  1. 1.Department of Child HealthUniversity of AberdeenUK
  2. 2.Royal Aberdeen Children's HospitalAberdeenUK

Personalised recommendations