1. Wheezy Infant
Prof.Dr.Reha Cengizlier

2. The most common causes of infantile wheezing are viral respiratory infections and asthma

3. Wheezing phenotypes
Young children have been grouped into three wheezing phenotypes :
Transient (onset ≤ 3 yr of age, then resolving)
Persistent (onset ≤ 3 yr of age and then persisting)
Late onset (onset of wheeze between 3-6 yr )

4. Frequency
-20% of all children will have had at least one wheezing illness by 1 yr of age
-33% by 3 yr of age
-50% by 6 yr
Less than 15% of children are subsequently diagnosed with asthma
Asthma is the most common disease of childhood and confers a significant degree of morbidity, thereby demanding early evaluation and management in the predisposed persistently wheezing infant

5. Risk factors The presence of atopy in the host
The development of lower respiratory tract infections;
Are the two most important independent risk factors for the development of persistent wheezing and asthma

6. Risk factors
The atopic state can influence lower airway response to viral infections, whereas viral infections may influence the development of allergy
Infection with RSV is the cause of the majority of lower respiratory tract illnesses with wheezing during the first 3 yr of life and may increase the risk of allergic sensitization later in childhood

7. Clinical findings Respiratory distress and breathing difficulty
The location of wheezing (unilateral, suggestive of a foreign body or bronchomalacia, or bilateral, suggestive of a more generalized process)
Wheezing and crackles (suggestive of an interstitial lung component including infection, bronchopulmonary dysplasia [BPD], or pulmonary edema with congestive heart disease)

8. Laboratory findings
Most infants with a single episode of wheezing will not require a chest radiograph, other than to confirm positive additional findings and/or to alleviate parental anxieties
Any child with recurrent episodes of wheezing or congenital anomalies should have anteroposterior and lateral radiographic views taken to ascertain the presence of hyperinflation and/or structural abnormalities
Suspicion of structural abnormalities may warrant additional imaging studies such as a CT or MRI and/or direct visualization using laryngobronchoscopy

9. Laboratory findings
The patient with an atopic family history and/or physical findings include allergy tests
Infant pulmonary function testing very rarely necessary to assess decreased lung function

10. Treatment
The treatment of infantile wheeze should be based on the underlying etiology
For viral-induced wheezing, management involves the use of supplemental oxygen to treat hypoxemia and a trial of bronchodilators
Systemic corticosteroids are not indicated for the treatment of acute viral bronchiolitis, and the role of inhaled corticosteroids used acutely remains controversial

11. Prognosis
The majority (60%) of children with early- onset wheezing will stop wheezing
A minority (15%) are at significant risk for persistent asthma

12. Prognosis
Based on the Tucson Children's Respiratory Study's asthma predictive index (API), young children with frequent wheezing episodes may be identified who are potentially at increased risk for the development of persistent asthma
Positive API:

13. Positive API one major criterion or two minor criteria
Frequent episodes of wheezing and
Parent with asthma or eczema
or two minor criteria
Serum eosinophilia (≥ 4%)
Wheezing not associated with an upper respiratory infection
Physician diagnosed allergic rhinitis during the first 3 yr of life

14. Differential diagnosis
Infection
Viral
Respiratory syncytial virus (RSV)  
Parainfluenza, Adenovirus, Influenza,   
Rhinovirus   
Other  
Chlamydia trachomatis,Tuberculosis,    
Histoplasmosis

15. Differential diagnosis
Asthma
Anatomic Abnormalities
Central airway abnormalities    
Malacia of the larynx, trachea, and/or bronchi    
Tracheoesophageal fistula (specifically H-type fistula)   
 Laryngeal cleft (resulting in aspiration)

16. Differential diagnosis
Extrinsic airway anomalies resulting in airway compression    
Vascular ring or sling    
Mediastinal lymphadenopathy
Mediastinal mass/tumor
Intrinsic airway anomalies    
Airway hemangioma    
Cystic adenomatoid malformation    
Bronchial/lung cyst    
Congenital lobar emphysema    
Aberrant tracheal bronchus    
Sequestration    
Congenital heart disease with left-to-right shunt (increased pulmonary edema)

17. Differential diagnosis
Inherited
Cystic fibrosis
Immunodeficiency states    
IgA deficiency    
B-cell deficiencies    
Primary ciliary dyskinesia    
Neonatal AIDS    
Bronchiectasis

18. Differential diagnosis
Bronchopulmonary Dysplasia
Aspiration Syndromes
Gastroesophageal reflux disease
Pharyngeal/swallow dysfunction
Interstitial Lung Disease, including Bronchiolitis Obliterans
Foreign Body

19. Body box pletismograph

20. Yabancı cisim aspirasyonu

21. Primer siliyer diskinezi- pnömotoraks

22. Kistik fibrozis

23. Çift aortik ark basısı