An 11-month-old infant who has had three viral respiratory illnesses causing bronchiolitis has parents who ask whether the infant may have asthma. What will the nurse practitioner tell the parents?

An 11-month-old infant who has had three viral respiratory illnesses causing bronchiolitis has parents who ask whether the infant may have asthma. What will the nurse practitioner tell the parents?

• A. Although it is likely, based on family history, it is too soon to tell.
• B. There is little reason to suspect that your infant has asthma.
• C. With your infant's history of bronchiolitis, asthma is very likely.
• D. Your infant has definitive symptoms consistent with a diagnosis of asthma.

Answer: (A)

In infants, you can’t diagnose asthma yet. Wheezing during viral infections like bronchiolitis is common, and having a family history of asthma raises the child’s risk, so there is some likelihood that asthma may develop later. But at 11 months, there isn’t enough information to make that diagnosis. Asthma is usually considered after preschool years when symptoms become more persistent and patterns emerge over time, since objective testing isn’t reliable in such young children. So the appropriate message is that there’s some increased risk because of family history, but it’s too early to tell. Ongoing monitoring and follow-up as the child grows will help determine whether persistent, recurrent symptoms develop that would suggest asthma. If wheezing becomes more frequent or occurs outside of viral illnesses, or nighttime symptoms appear, evaluation can be revisited.

In infants, you can’t diagnose asthma yet. Wheezing during viral infections like bronchiolitis is common, and having a family history of asthma raises the child’s risk, so there is some likelihood that asthma may develop later. But at 11 months, there isn’t enough information to make that diagnosis. Asthma is usually considered after preschool years when symptoms become more persistent and patterns emerge over time, since objective testing isn’t reliable in such young children.

So the appropriate message is that there’s some increased risk because of family history, but it’s too early to tell. Ongoing monitoring and follow-up as the child grows will help determine whether persistent, recurrent symptoms develop that would suggest asthma. If wheezing becomes more frequent or occurs outside of viral illnesses, or nighttime symptoms appear, evaluation can be revisited.