Viral Respiratory Infections and Treatment in Pediatric Asthma

Most Common Cause of Respiratory Infections Exacerbating Asthma

Viral respiratory infections are the predominant trigger for asthma exacerbations in children under 5 years of age 1
Among children 5 years and younger, viral respiratory infections are the most common cause of asthma-like symptoms 2, 3
These infections can lead to significant morbidity, with many children requiring emergency department visits or hospitalizations 4, 5

Inhaled corticosteroids are the preferred treatment option for long-term control of persistent asthma in children, as recommended by the American Academy of Allergy, Asthma, and Immunology 1, 3
They are recommended as first-line therapy for mild persistent asthma at low doses, with a strength of evidence rated as high 3
For moderate persistent asthma, either low-dose inhaled corticosteroids with long-acting beta2-agonists OR medium-dose inhaled corticosteroids is preferred, with a strength of evidence rated as moderate 1
The American Thoracic Society recommends short-acting beta-agonists as the mainstay of immediate treatment for acute exacerbations 6
Systemic corticosteroids should be administered for severe exacerbations, with dosages of 30-60 mg prednisolone for adults and 1-2 mg/kg body weight for children, as recommended by the National Asthma Education and Prevention Program 6

Long-term control therapy should be strongly considered in children who have had more than three episodes of wheezing in the past year lasting more than 1 day and affecting sleep, AND have risk factors for persistent asthma, as recommended by the American Academy of Pediatrics 2
Children who require symptomatic treatment more than twice weekly or experience severe exacerbations less than 6 weeks apart should also be considered for long-term control therapy, with a strength of evidence rated as high 2

Regular assessment of asthma control is essential, with monitoring of days off school due to asthma, daytime and nighttime symptoms, need for rescue medications, and activity limitations, as recommended by the Global Initiative for Asthma 6
Height and weight should be documented regularly to monitor for potential growth effects of corticosteroids, with a strength of evidence rated as moderate 6

Asthma in early childhood is frequently underdiagnosed, receiving labels such as chronic bronchitis, wheezy bronchitis, or recurrent pneumonia, as noted by the American Academy of Allergy, Asthma, and Immunology 1, 3
Not all wheezing and coughing in children is due to asthma; consider other conditions like cystic fibrosis, foreign body aspiration, or congenital heart disease, with a strength of evidence rated as high 1, 3
Hyposensitization (immunotherapy) is not indicated in the management of asthma, as stated by the American Thoracic Society 6
Antibiotics have no place in the management of uncomplicated asthma but may be indicated when specific infections like M. pneumoniae are suspected, with a strength of evidence rated as moderate 6