Wheezing Babies: Is it Asthma or Something Else?

Not even the doctor knows the answer to this question until time, trial and error reveal the truth. But the secret to preventing severe symptoms is never allowing them to become severe in the first place. Alas, how do you know if you should treat the symptoms as if they're caused by asthma? Are you over- or under-medicating your baby? At what point do you say the treatment plan is or isn’t working?

Figuring out why a baby is wheezing is a little like trying to tango to a waltz. That’s why we were most interested to see new research published in the June 2010 issue of the Journal of Allergy and Clinical Immunology (JACI) demonstrating the virtues of measuring exhaled nitric oxide, a non-invasive marker of airway inflammation in babies. I thought you might want to share the article with your pediatrician or asthma specialist, so I’ve posted it below. We’re also posting it on the new website for AANMA’s Great American Asthma Challenge.

Aerocrine makes NioxMino, the small portable device that measures exhaled nitric oxide. If inflammation is detected, the physician can prescribe an inhaled corticosteroid to use while the cause of inflammation is sorted out. If inflammation is not present, the physician knows to look for other causes of symptoms.

The only downside: the test is not always reimbursed by insurance companies -- yet. Work with AANMA to let insurance companies know just how important it is to reimburse for diagnostic tests and monitoring that allow us and our children to zero in on the causes of asthma and treat them more specifically and strategically so we can move on with our lives. Sign up for the Great American Asthma Challenge, and e-mail editor@aanma.org to get added to our list of potential advocacy contacts on reimbursement issues.

Journal of Allergy and Clinical Immunology Highlights - June 2010

Exhaled nitric oxide, lung function, and exacerbations in wheezy infants

Clinicians generally cannot distinguish infants and toddlers with transient wheezing from those with early persistent asthma. Debley et al recruited 47 infants and toddlers with three or more prior episodes of physician diagnosed wheeze into a longitudinal study to determine whether exhaled nitric oxide (FENO) was associated with lung function, response to bronchodilators, changes in lung function over time, or subsequent exacerbations of wheezing.

They used a flow regulated (50 mL/sec) single-breath method to measure FENO, and the raised-volume thoracic compression method to measure lung function with assessment of albuterol responsiveness. The authors found that FENO was associated with bronchodilator responsiveness, and that higher levels of enrollment FENO were associated with subsequent decline in lung function and exacerbations of wheezing treated with systemic steroids over 6 months. Enrollment FENO was superior to both enrollment lung function and bronchodilator responsiveness in predicting subsequent exacerbations of wheezing.

Although follow-up into the school-age years with a larger cohort is needed to definitively evaluate the predictive value for asthma, these data suggest that FENO measurement in wheezy infants and toddlers is a promising objective biomarker that may prove useful clinically and improve our understanding of the evolution of asthma in young children.

--“Exhaled Nitric Oxide, Lung Function, and Exacerbations in Wheezy Infants and Toddlers” Remarks by Debley et al. (JACI June 2010 / Volume 125, No. 6

The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

PRECIOUS Breathers is AANMA’s special program to help you identify respiratory problems in children under 5. Everything about PRECIOUS Breathers is geared to little ones and the big people who love them! Here, you’ll find basic info about various reasons why your child might be having breathing problems—from common causes such as colds and teething, to more serious conditions such as asthma that require medical treatment. You’ll also find an online library of practical, family-friendly articles about some of the specific causes.