Bronchiolitis & Types of Childhood Asthma


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Bronchiolitis is the first episode of wheezing in children less than 12-months of age in a viral respiratory tract infection setting.

Parents see a specialist, a pediatric pulmonologist, when their child has been diagnosed with recurrent episodes of bronchiolitis resulting in multiple primary care visits, urgent care or emergency room visits, or admissions to the hospital with a wheezing illness. Most times, the child is treated with a bronchodilator, albuterol nebs, steroids, and antibiotics.

The most common concern that parents have at the time of an initial visit with a specialist is if their child has asthma. A pattern of recurrent wheezing with a viral respiratory illness is seen in children with an intermittent childhood asthma pattern, which is by far the most common.

Three distinct clinical patterns of asthma can be seen in childhood:

1) Intermittent
Intermittent pattern asthma is most common, in which symptoms occur exclusively following the viruses that cause the common cold. These children are completely symptom-free during the intercurrent periods.

2) Chronic
The chronic pattern of asthma is associated with persistent symptoms. While exacerbations may occur with viral respiratory illnesses as is seen in the more common intermittent pattern, these children have daily or near-daily symptoms of asthma, even between such exacerbations. Children with chronic pattern asthma also have other risk factors, including eczema, food allergies, and environmental allergies.

3) Seasonal Allergic
Seasonal allergic patterns are usually associated with symptoms during the spring and fall season.

The pattern of asthma determines treatment. Chronic pattern asthma needs treatment with daily inhaled corticosteroids (ICS) to control the lungs’ chronic inflammation.

The management of intermittent asthma is not very clear cut. Therefore a thorough history of the severity of exacerbations, frequency of exacerbations, daycare exposures, family history, and other risk factors are considered before committing to daily controller medications.

Inhaled corticosteroids (ICS) are administered via inhaler and spacer device with a mask (younger kids) or a mouthpiece (older kids); most kids do well on ICS. The most common side effect is oral thrush (fungal growth in the mouth), which is easily avoidable by oral hygiene following drug administration.

If you are concerned about your child’s health, Fairfax Neonatal Associates’ Pediatric Lung & Allergy Center (PLAC) provides comprehensive care to infants and children needing allergy and immunology diagnoses and treatment.


Fairfax Neonatal Associates’ Pediatric Lung & Allergy Center (PLAC) provides comprehensive care to infants and children needing allergy and immunology diagnoses and treatment. PLAC pediatric specialists provide a wide range of evaluations and testing for allergens, immune and lung function, oral food challenges, and more — all leading to individualized treatment plans with your child’s pediatrician.

Learn more about Fairfax Neonatal Associates’ providers here. Connect with their Pediatric Lung & Allergy Center online or by calling their Fairfax, VA, location at (703) 289-1410.



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