Treatment for a Child with Persistent Chest Congestion and Wheezing

Diagnostic Considerations

The American Thoracic Society suggests that the presentation of persistent symptoms despite antibiotic therapy may indicate inadequate treatment of bacterial infection, viral etiology, or underlying reactive airway disease/asthma 2, 3
The development of wheezing with crackles after failed antibiotic therapy suggests possible bronchospasm component requiring bronchodilator therapy, according to the American College of Chest Physicians 1, 5
Possible anatomic abnormality may be present in children with persistent symptoms, as suggested by the American Academy of Pediatrics 1, 4

The American Academy of Pediatrics recommends beginning bronchodilator therapy (albuterol) to address the new wheezing component in children with persistent chest congestion and wheezing 1, 5
Consideration of a 3-5 day course of oral corticosteroids is recommended if wheezing is moderate to severe, according to the American College of Chest Physicians 1, 5
Addition of inhaled corticosteroids may be necessary if wheezing persists despite bronchodilator therapy, as suggested by the American Thoracic Society 1, 5

Approximately 33% of children with persistent wheezing may have an anatomic abnormality identifiable by airway survey, according to the American College of Chest Physicians 4, 2
40-60% of children with persistent wheezing may have a positive BAL culture indicating bacterial infection, as reported by the American Thoracic Society 2, 3
Consideration of flexible fiberoptic bronchoscopy with bronchoalveolar lavage may be necessary to identify anatomic abnormalities or bacterial infection in children with recurrent or persistent wheezing, according to the American Academy of Pediatrics 1, 8, 2