Official American thoracic society clinical practice guidelines: Diagnostic evaluation of infants with recurrent or persistent wheezing

Clement L. Ren, Charles R. Esther, Jason S. Debley, Marianna Sockrider, Ozge Yilmaz, Nikhil Amin, Alia Bazzy-Asaad, Stephanie D. Davis, Manuel Durand, Jeffrey M. Ewig, Hasan Yuksel, Enrico Lombardi, Terry L. Noah, Peggy Radford, Sarath Ranganathan, Alejandro Teper, Miles Weinberger, Jan Brozek, Kevin C. Wilson

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Background: Infantile wheezing is a common problem, but there are no guidelines for the evaluation of infants with recurrent or persistent wheezing that is not relieved or prevented by standard therapies. Methods: An American Thoracic Society-sanctioned guideline development committee selected clinical questions related to uncertainties or controversies in the diagnostic evaluation of wheezing infants. Members of the committee conducted pragmatic evidence syntheses, which followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The evidence syntheses were used to inform the formulation and grading of recommendations. Results: The pragmatic evidence syntheses identified few studies that addressed the clinical questions. The studies that were identified constituted very low-quality evidence, consisting almost exclusively of case series with risk of selection bias, indirect patient populations, and imprecise estimates. The committee made conditional recommendations to perform bronchoscopic airway survey, bronchoalveolarlavage,esophagealpHmonitoring,andaswallowing study.Italsomadeconditionalrecommendationsagainstempiricfood avoidance, upper gastrointestinal radiography, and gastrointestinal scintigraphy. Finally, the committee recommended additional research about the roles ofinfantpulmonaryfunction testingand food avoidance or dietary changes, based on allergy testing. Conclusions: Although infantile wheezing is common, there is a paucity of evidence to guide clinicians in selecting diagnostic tests for recurrent or persistent wheezing. Our committee made several conditional recommendations to guide clinicians; however, additional research that measures clinical outcomes is needed to improve our confidence in the effects of various diagnostic interventions and to allow advice to be provided with greater confidence.

Original languageEnglish (US)
Pages (from-to)356-373
Number of pages18
JournalAmerican journal of respiratory and critical care medicine
Volume194
Issue number3
DOIs
StatePublished - Aug 1 2016

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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    Ren, C. L., Esther, C. R., Debley, J. S., Sockrider, M., Yilmaz, O., Amin, N., Bazzy-Asaad, A., Davis, S. D., Durand, M., Ewig, J. M., Yuksel, H., Lombardi, E., Noah, T. L., Radford, P., Ranganathan, S., Teper, A., Weinberger, M., Brozek, J., & Wilson, K. C. (2016). Official American thoracic society clinical practice guidelines: Diagnostic evaluation of infants with recurrent or persistent wheezing. American journal of respiratory and critical care medicine, 194(3), 356-373. https://doi.org/10.1164/rccm.201604-0694ST