Asthma, Bronchiolitis and Croup are all common causes of respiratory distress and high-pitched respiratory noises (wheeze or stridor) in young children, and determining the correct diagnosis can be challenging. The diagnosis is important, because the management of these conditions is quite different. Bronchiolitis causes wheezing and dyspnea but is uncommon after 1 year of age, and asthma is quite rare in children less than one, which helps narrow the diagnosis. Recurrent episodes - particularly after a child turns 1, and in a child with a clear, immediate response to bronchodilator, is most often due to asthma. Asthma can nearly always be controlled in children with regular use of an anti-inflammatory medication (most often an inhaled corticosteroid) and as-needed bronchodilator. This is true even in younger children with viral-triggered, intermittent asthma. It's important to note that inhaled steroids need 1-6 weeks of regular use to start working. In contrast, the evidence suggests that the main treatments for bronchiolitis are supportive - oxygen and fluids, when needed. Croup causes inspiratory stridor, a barky cough, and dyspnea. Severe episodes respond to systemic steroid (dexamethasone) and nebulized epinephrine. Children with recurrent episodes should be evaluated for structural upper airway lesions. Children with recurrent idiopathic croup and a reliable caregiver may benefit from taking a dose of dexamethasone or high-dose nebulized corticosteroid (budesonide) at home.
Children's Hospital of Eastern Ontario, University of Ottawa
Dr. Tom Kovesi is a pediatric respirologist and Professor of Pediatrics at the University of Ottawa. He is past-Chair of the Pediatric Assembly of the Canadian Thoracic Society, past-chair of the Ontario Thoracic Society, and past-Chief Examiner (Pediatric Respirology) for the Royal College. He is a Content Expert (Respirology), Faculty of Medicine, uOttawa. He's been a senior author on the Canadian Asthma Consensus Guidelines Committee, and has over 45 published articles in the areas of asthma guidelines, exhaled nitric oxide in children with asthma, and his main research interest: indoor air quality and lung disease in Canadian indigenous children.
Thursday, November 23
10:45 AM – 11:45 AM
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