A shockingly high percentage of children with recurrent wheezing are suffering from "silent" lung infections, and that has big implications for the treatment these kids should receive.
Our W. Gerald Teague, MD, a pediatric pulmonologist at UVA Health Children's, and colleagues screened more than 800 children with recurrent wheezing and found that 22% had undiagnosed, asymptomatic lung infections. Rhinoviruses were by far the most common cause, but the researchers identified other stubborn viral infections as well.
This is notable because viruses do not respond to the corticosteroids commonly used to treat recurrent wheezing. These children would be better treated with antivirals, the researchers say. In addition to being more effective, antivirals would spare children side effects of high-dose corticosteroids, which can include reduced bone density and stunted growth.
“I advise the parents of my patients that wheeze episodes that are triggered by colds should be treated with anti-inflammatory medications that build immunity to viruses, such as azithromycin," Dr. Teague said. "They look surprised that we would use an antibiotic for a viral infection, but, in fact, azithromycin bolsters the immune response to viruses in a positive way.”
Dr. Teague and his collaborators are uncertain why so many children are suffering these stubborn viral infections -- they suspect something may be going awry with the mucosal immune cells in the children’s lungs. The problem seems to affect children who are very young, primarily, and becomes less common by school age.
Dr. Teague hopes the findings will help doctors better treat recurrent wheeze. He also plans to investigate whether this type of faulty immune response in children may be a risk factor for asthma.