Treatment of recurrent wheezing/asthma in the child under three years of age

Today's guides and consensus emphasize the importance of asthma control in diminishing morbidity and improving these patients' quality of life. This control is not easy in children under 3 years of age due to: recurrent wheezing phenotype heterogeneity, triggering factors and predominant inflammatory pattern (probably different), and variable evolution and treatment response.

Identifying the wheezing phenotype could help making therapeutic decisions. However, characteristics from different phenotypes can sometimes overlap in a patient, so the treatment should be adjusted according to the patient's response.

We review the 3 basic pillars of treatment: education, preventive measures and drug treatment. We do this for the acute episode and for the treatment maintenance.

The recommended drugs on children under 3 are inhaled corticoids (IC) and leukotriene inhibitors. IC are the treatment of choice for asthma and there is a better response on children with wheezing plus atopy. There is no evidence in the recommendation of low IC doses in the prevention of wheezing episodes exclusively triggered by virus on children of this age. Leukotriene inhibitors are more appropriate in these cases. They are an alternative to IC on children with mild asthma and they could be used to decrease exacerbations induced by virus.

Some children, however, do not respond to any of these drugs. It is recommended to review the treatment periodically and suspend it or consider an alternative treatment or diagnosis if benefits are not observed.