Het jonge kind met recidiverend piepen, hoesten en kortademigheid

Episodes of dyspnea and wheeze following upper respiratory tract infections are common in young children. Because these symptoms usually resolve spontaneously over time, and because there is no evidence of airway inflammation in this age group (which is the hallmark of asthma in older children and adults), the term 'asthma' should be avoided. A positive family history and sensitization to inhalant allergens increase the likelihood of symptoms persisting beyond the age of 6 years, and increase the risk of asthma. Unfortunately, the risk of persistence or resolution of symptoms over time cannot be predicted reliably in individual cases. Treatment of acute severe dyspnea and wheeze consists of inhaled short-acting β₂-agonists and, in children younger than 1 year, a course of oral corticosteroids. Long-term management includes education, avoiding tobacco smoke exposure, inhalation instruction, and the use of inhaled short-acting β₂- agonists on demand by metered dose inhaler with spacer. In children with more severe symptoms and presence of risk factors for asthma (such as a positive family history and sensitization to inhalant allergens), maintenance treatment with inhaled corticosteroids is recommended. In children who only wheeze with viral respiratory tract infection, without risk factors for asthma, international guidelines recommend treatment with the leukotriene antagonist montelukast. Unfortunately, the effect of maintenance treatment is disappointing in very young children.