Management of Recurrent Wheezing in Children with Atopic History

Diagnosis and Treatment

The American Academy of Allergy, Asthma, and Immunology recommends considering daily long-term control therapy for young children who had 2 or more episodes of wheezing in the past year that lasted >1 day, with evidence of atopic disease including physician diagnosis of atopic dermatitis 1
Children with early childhood eczema have a 34.1% risk of developing asthma, with likelihood related to dermatitis severity, according to the American Academy of Otolaryngology-Head and Neck Surgery 2
Inhaled corticosteroids are the most effective long-term control therapy for persistent asthma in children and should be initiated when specific criteria are met, as recommended by the American Academy of Allergy, Asthma, and Immunology 1

The American Academy of Allergy, Asthma, and Immunology recommends starting with low-dose inhaled corticosteroids as first-line controller therapy, with options including budesonide nebulizer solution and fluticasone via metered-dose inhaler with spacer device 1, 4, 8
The use of short-acting beta-agonists (albuterol/salbutamol) for acute symptom relief is recommended, but they should not be relied upon solely, as they do not address the underlying airway inflammation, according to the American Academy of Allergy, Asthma, and Immunology 4, 6

Close monitoring of response to treatment over 4-6 weeks is recommended, with reassessment to evaluate treatment response and document frequency of daytime symptoms, nighttime awakening, activity limitation, and school absences, as suggested by the American Academy of Allergy, Asthma, and Immunology 1, 4, 5
Consider stepping down therapy after 3 months of good control, as young children have high rates of spontaneous remission, according to the American Academy of Allergy, Asthma, and Immunology 1