Diagnostic Evaluation of Infants with Recurrent or Persistent Wheezing
Publication Date: August 3, 2016
Last Updated: December 16, 2022
Diagnosis
For infants with persistent wheezing despite treatment with bronchodilators, inhaled corticosteroids, or systemic corticosteroids, the ATS suggests an airway survey via flexible fiberoptic bronchoscopy. (C, VL)
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For infants with persistent wheezing despite treatment with bronchodilators, inhaled corticosteroids, or systemic corticosteroids, the ATS suggests bronchoalveolar lavage (BAL). (C, VL)
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The ATS recommends research studies in infants with persistent wheezing despite treatment with bronchodilators, inhaled corticosteroids, or systemic corticosteroids, which compare clinical outcomes among those who are managed according to results from infant pulmonary function testing using the raised-volume rapid thoracoabdominal compression (RVRTC) method versus those who are managed according to clinical assessment alone.
For infants who do not have eczema but have persistent wheezing despite treatment with bronchodilators, inhaled corticosteroids, or systemic corticosteroids, the ATS suggests that clinicians and caregivers do NOT use empiric food avoidance or dietary changes. (C, VL)
The ATS recommends research studies that determine if food avoidance or dietary changes guided by food allergy testing improves clinical outcomes in infants who do not have eczema but have persistent wheezing despite treatment with bronchodilators, inhaled corticosteroids, or systemic corticosteroids.
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For infants with persistent wheezing despite treatment with bronchodilators, inhaled corticosteroids, or systemic corticosteroids, the ATS suggests 24-hour esophageal pH monitoring. (C, VL)
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For infants with persistent wheezing despite treatment with bronchodilators, inhaled corticosteroids, or systemic corticosteroids, the ATS suggests 24-hour esophageal pH monitoring rather than upper gastrointestinal radiography. (C, VL)
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For infants with persistent wheezing despite treatment with bronchodilators, inhaled corticosteroids, or systemic corticosteroids, the ATS suggests 24-hour esophageal pH monitoring rather than gastrointestinal scintigraphy. (C, VL)
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For infants with persistent wheezing despite treatment with bronchodilators, inhaled corticosteroids, or systemic corticosteroids, the ATS suggests performing videofluoroscopic swallowing studies. (C, VL)
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Recommendation Grading
Overview
Title
Diagnostic Evaluation of Infants with Recurrent or Persistent Wheezing
Authoring Organization
American Thoracic Society
Publication Month/Year
August 3, 2016
Last Updated Month/Year
March 25, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Male, Female, Infant
Health Care Settings
Ambulatory, Emergency care
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis
Keywords
wheezing, infant wheezing