The wheezy infant: A viewpoint from low-middle income countries

• Published in: Paediatric respiratory reviews 2024-09, Vol.51, p.32-37
• Main Authors: Mocelin, Helena Teresinha, da Silva Filho, Luiz Vicente Ribeiro Ferreira, Castro-Rodriguez, Jose A., Sarria, Edgar E., Fischer, Gilberto Bueno
• Format: Article
• Language: English
• Subjects: Asthma; Asthma - diagnosis; Asthma - epidemiology; Asthma - therapy; Child, Preschool; Developing Countries; Diagnosis, Differential; Humans; Infant; Infant, Newborn; Recurrence; Recurrent wheezing; Respiratory Sounds - etiology; Wheezing Infant
• ISSN: 1526-0542; 1526-0550; 1526-0550
• DOI: 10.1016/j.prrv.2022.06.001

•Wheezing infants are an important global public health issue in LIMC.•Determining whether wheezing is the correct definition is critical.•A differential diagnosis of the causes of wheezing and other sounds should be made.•Recurrent wheezing [RW] in infants may warrant a therapeutic trial with inhaled steroids.•In LMICS, RW may be prevented by reducing environmental factors such as smoking.•Early exposure to viral infection is a preventable cause of RW. To review the recent evidence in the literature of various aspects of recurrent/severe wheezing in children under 3 in low-middle income countries [LMICS]. A non-systematic review including articles in English. We mainly selected publications from the last 5 years. Studies on epidemiology, aetiology, diagnosis, treatment, and prevention were included in the search. We reviewed differential diagnoses of wheezing that focused on LMICS. We also reviewed aspects of prevention. Many epidemiological studies have shown a variable but significant number of wheezy infants [WI] cases in LMICS when compared to other countries. The differential diagnosis of causes of wheezing in this age group is mandatory, taking into account local facilities. Few treatment options have been well studied for this age group. In LMICS, a pragmatic approach could be considered, as described in the article. It is difficult to study primary prevention for WI and secondary prevention (mainly environmental) may have some impact. A schematic approach for recurrent wheezers is presented, which takes into account settings with limited resources. Severely or recurrently wheezy children under 3 is a common clinical issue in LMICS. Studies on this age group are needed to reduce the significant morbidity. It may be possible to lower the high burden of wheezing in this age group by selecting the phenotype which may respond to inhaled steroids.