Asthma-like symptoms in infants and toddlers is often RAD

Your child is wheezing. Your child must have asthma, right? Not always, says Julie Koehler, professor and chair of the Department of Pharmacy Practice in Butler University's College of Pharmacy and Health Sciences and clinical pharmacy specialist in family medicine at Clarian Health.

While wheezing (a high-pitched whistling sound heard during exhalation) is a classic sign of asthma, it's also a symptom of viral respiratory tract infections and reactive airway disease (RAD).

Viral respiratory tract infections can result from the common cold and influenza. In children up to 4 years of age, the infection often resides in the lower respiratory tract — the windpipe, airways and lungs. Because the airways of young children are small, wheezing and coughing, which mimic the symptoms of asthma, can occur as a result of the infection.

For infants and toddlers who do not have an infection but are experiencing asthma-like symptoms, RAD is often the diagnosis. This diagnosis simply means your child is experiencing asthma-like symptoms, but a definitive diagnosis of asthma cannot be made yet because the child is too young. Definitively diagnosing asthma in infants and toddlers is often difficult, because children under the age of 5 are not usually able to perform the special lung function testing that is often used in making the diagnosis.

Although it is possible that children who are labeled as having RAD may continue to have symptoms and ultimately go on to develop asthma, medications such as albuterol, which work to relax and open airways and relieve shortness of breath, are often prescribed when symptoms of wheezing are present. Data suggests that up to half of all children may have at least one episode of wheezing before age 3, but only about one-third of those children will definitively develop asthma before the age of 6.

So, at what point should a child who has been diagnosed with RAD be considered to have asthma? Here are some signs to look for:

1) Wheezing that doesn't go away or keeps recurring. Be on the lookout especially for wheezing episodes that have occurred at least four times in a year, have lasted for more than one day and/or have affected your child's ability to sleep.

2) Frequent coughing (especially at night) or coughing that worsens after physical activity or active play.

3) A diagnosis of eczema or atopic dermatitis (a dermatologic condition characterized by skin irritation and usually associated with allergies).

4) A parental history of asthma, allergies or eczema.

5) Evidence of sensitization to aeroallergens (such as hay fever).

6) Evidence of allergy or sensitization to foods.

7) A finding of greater than or equal to four percent eosinophils (a kind of white blood cell) in the bloodstream.

For children who have intermittent asthma symptoms (i.e., not more than twice weekly), albuterol may be enough to adequately control your child's symptoms. For children who experience symptoms more often than twice weekly, or for children whose sleep is being affected by symptoms of asthma, a daily anti-inflammatory medication, such as an inhaled corticosteroid, is often necessary in addition to albuterol in order to gain optimal control of your child's symptoms and to potentially minimize the chronic airway damage that can be caused by inflammation.

If you or your pediatrician suspects that your child may have asthma, a conversation about initiating proper treatment is definitely warranted.