Asthma Under Five Years

As per the recent scientific literature we do not label a child under 5 as asthma.

Many young children have wheezing or commonly called as chest congestion with viral colds. Viral colds can happen in healthy children 10-15 times in a year. In some of these colds children can have wheezing. In how many they would have a wheezing of these colds has to be seen by your doctor. Some might have only one or two times a year. Some might have it very frequently almost with every cold. These children would typically be absolutely well in between the episodes.

As such children would grow older these colds would reduce and also the wheezing episodes. These children cannot be labelled as asthma, although the treatment might appear similar. As per the current understanding these child as called as “Episodic Viral Wheezers”. It also needs to be remembered that most of these episodes are viral and hence do not need unnecessary antibiotics.

There would be some children who would behave a bit differently. They might have some symptoms in between episodes like cough on exercise or jumping or playing. Some might have problems with allergens and irritants like dust, smoke, strong smell like deo’s or perfumes or paints. Some of these children might have an allergic skin called as a “Atopic dermatitis”. These also might be a history of asthma in the family. If the child has none of these features then the chances of outgrowing the disease are high. The chances of this wheezing developing into asthma increases with more and more factors being present. These children are called as “Multi-trigger wheezing”.

There is no single investigation which can predict which child will go on to develop asthma later on in life.

Can there be any other diagnosis except “Episodic viral wheezing” or “Multi-trigger wheezing”?

There can be other not so common causes like

  • Infections: bacterial bronchitis, chronic suppurative lung disease, bronchiectasis (swollen and dilated airways), tuberculosis
  • Congenital problems: Tracheo-bronchomalacia, cystic fibrosis, primary ciliary dyskinesia, Immune deficiency, compression or the windpipe due to a blood vessel or a lymph node, H type Tracheo-esophageal fistula (abnormal communication between the windpipe and feeding pipe)
  • Mechanical Problems: like gastroesophageal reflux and foreign body aspirations

What are the red flag signs or indicators of a possible severe cause of wheeze?

  • Not gaining adequate weight
  • Presence of persistent cough with phlegm
  • Wheezing persisting for more than 4 weeks
  • Stridor/noisy breathing
  • Age of onset less than 6 months
  • Severe wheeze episodes requiring hospital admissions

How do we evaluate a child with recurrent or persistent wheezing?

  • Initially we would take a detailed history and examine the child. This would be followed by review of all old records and chest xrays if any.
  • Initial investigations would include a basic blood tests and a chest x-ray.
  • Some children might need further investigations to identify the cause of wheezing like a flexible bronchoscopy, CT scan of chest, investigations for Gastro-esophageal reflux, etc.