title: Official American Thoracic Society Clinical Practice Guidelines: Diagnostic Evaluation of Infants with Recurrent or Persistent Wheezing.
abstract: 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.
  
  
  
  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.
  
  
  
  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, bronchoalveolar lavage, esophageal pH monitoring, and a swallowing study. It also made conditional recommendations against empiric food avoidance, upper gastrointestinal radiography, and gastrointestinal scintigraphy. Finally, the committee recommended additional research about the roles of infant pulmonary function testing and food avoidance or dietary changes, based on allergy testing.
  
  
  
  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.
authors.forename: Clement L
authors.identifier: 0000-0003-4431-0644
authors.initials: CL
authors.lastname: Ren
authors.forename: Charles R
authors.initials: CR
authors.lastname: Esther
authors.forename: Jason S
authors.initials: JS
authors.lastname: Debley
authors.forename: Marianna
authors.initials: M
authors.lastname: Sockrider
authors.forename: Ozge
authors.initials: O
authors.lastname: Yilmaz
authors.forename: Nikhil
authors.initials: N
authors.lastname: Amin
authors.forename: Alia
authors.initials: A
authors.lastname: Bazzy-Asaad
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Davis
authors.forename: Manuel
authors.initials: M
authors.lastname: Durand
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Ewig
authors.forename: Hasan
authors.initials: H
authors.lastname: Yuksel
authors.forename: Enrico
authors.initials: E
authors.lastname: Lombardi
authors.forename: Terry L
authors.initials: TL
authors.lastname: Noah
authors.forename: Peggy
authors.initials: P
authors.lastname: Radford
authors.forename: Sarath
authors.initials: S
authors.lastname: Ranganathan
authors.forename: Alejandro
authors.initials: A
authors.lastname: Teper
authors.forename: Miles
authors.initials: M
authors.lastname: Weinberger
authors.forename: Jan
authors.initials: J
authors.lastname: Brozek
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Wilson
mesh_terms: D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012008:Recurrence; D012129:Respiratory Function Tests; D012135:Respiratory Sounds / Q000175:diagnosis*; D012952:Societies; D014481:United States