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Pfeifende Atmung («Wheezing») beim Säugling und Kleinkind: Aktuelle Standpunkte

Wheezing in infants and toddlers: New insights

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Summary

Wheezing in infants and toddlers is a common symptom, and these patients are difficult to approach — both diagnostically and therapeutically. Congenital conditions causing wheezing disorders should not be missed and — not all wheezy bronchitis is or will become asthma. Results from longitudinal studies indicate that the term «asthma» includes different phenotypes: so-called transient early wheezing, non atopic wheezing and atopic wheezing (asthma).Transient early wheezing is generally accepted to define recurrent wheezing in non-atopic babies or toddlers and tends to disappear by the age of 3. The primary risk factor is reduced pulmonary function since birth. The most common cause fornon-atopic wheezing is viral infection, most frequently caused by respiratory syncytial virus. Infection with respiratory syncytial virus is a risk factor for ongoing wheeze during childhood but resolves in most children by the age of 13.Asthma can start at any age and is determined by a more chronic condition, provoked by a number of triggers in addition to viruses, frequently associated with a family history of atopy, early allergic sensitization and concomitant atopic dermatitis. Only asthma seems to be a progressive disease; and there is evidence from long-term studies that if anti-inflammatory interventions are started late, it might be too late to alter the natural course of the disease with its decline in pulmonary function. On the other hand, there is no evidence that small children with non-atopic wheezy bronchitis would benefit from long-term therapy with anti-inflammatory treatment; in this group a therapeutic trial with bronchodilators is sufficient. The diagnostic and therapeutic challenges of diagnosing asthma in this age group are considerable and require a comprehensive approach.

Zusammenfassung

Die pfeifende Atmung («Wheezing) beim Säugling und Kleinkind ist ein häufiges Symptom das zur diagnostischen und therapeutischen Herausforderung werden kann. Differentialdiagnostische Überlegungen spielen in dieser Altersgruppe eine besondere Rolle und nicht jedes Wheezing ist oder wird zu Asthma bronchiale. Die Ergebnisse von Langzeitstudien zeigen, dass es verschiedene «Asthmaphänotypen» gibt, das «transient early wheezing», das «non atopic wheezing» und «das atopic wheezing (asthma)».Transient early wheezing findet sich vor allem Säuglingen und Kleinkindern ohne Hinweis für eine Atopie und verschwindet üblicherweise im Alter von ca. 3 Jahren. Ursache hierfür sind eine schon bei Geburt verminderte Lungenfunktion im Sinne kleiner Atemwege. Der häufigste Grund für dasnon atopic wheezing sind Virusinfektionen, vor allem mit dem Respiratory Syncytial Virus, welche einen Risikofaktor für wheezing während der Kindheit bedeuten. Die Symptomatik verliert sich aber um das 13. Lebensjahr.Asthma kann in jedem Alter beginnen und ist charakterisiert durch einen mehr chronischen Verlauf, Auslöser sind neben viralen Infektionen eine Reihe anderer Ursachen: eine positive Familienanamnese bezüglich Atopie, eine frühe allergische Sensibilisierung und eine begleitende atopische Dermatitis. Wie aus den Longitudinalstudien hervorgeht ist nur Asthma im engeren Sinne eine progressive Erkrankung. Daten aus Longitudinalstudien zeigen, dass bei Asthma bronchiale der Verlust an Lungenfunktion bereits in früher Kindheit beginnt und therapeutische Interventionen rechtzeitig begonnen werden sollten, um einen irreversiblen Verlust an Lungenfunktion zu verhindern. Andererseits ist im Falle einer gelegentlichen «Wheezy bronchitis» ein symptomorientierter Therapieversuch mit Bronchodilatoren ausreichend. Im frühen Kindesalter ist oft eine zuwartende Haltung unumgänglich und die Diagnose Asthma kann häufig erst retrospektiv gestellt werden.

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  1. Kinderpneumologie/Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde Innsbruck, Anichstraße 35, A-6020, Innsbruck, Österreich

    Elisabeth Horak

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Horak, E. Pfeifende Atmung («Wheezing») beim Säugling und Kleinkind: Aktuelle Standpunkte. Wien Klin Wochenschr 116, 15–20 (2004). https://doi.org/10.1007/BF03040418

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