CURE WHEEZING, GETTING RID OFF TEMPORARILY IS NOT A SOLUTION !
Reconsidering the Use of Steroids and Antibiotics in Childhood Wheezing and Asthma: A Research Perspective
Wheezing and asthma are very common among children in India, especially during winter. It is common in clinical practice to initiate antibiotics and, if symptoms worsen, introduce steroids to provide relief. However, there is growing concern among some researchers and some knowledgeable parents that this approach, while well-intended, may carry long-term risks if not medically warranted. It’s time we understand what’s really happening—and how to treat it the right way.
Wheezing and Asthma Are Not Caused by Bacteria
This is the most important point. Wheezing and asthma are not caused by bacterial infections in most cases. Hence, antibiotics, designed to combat bacteria, may not address the primary cause and can contribute to issues like antibiotic resistance if used indiscriminately. These drugs may appear to provide temporary relief, but they do not address the real cause and may create long-term problems like antibiotic resistance or even resistance to common medications.
Pneumonia Is Bacterial. Asthma Is Inflammatory.
Many people confuse pneumonia with wheezing or asthma, as all involve breathing difficulties. But pneumonia is a bacterial infection of the lungs and can be treated with antibiotics.
Asthma, however, is not an infection. It’s a chronic inflammatory condition that causes the airways to narrow and produce extra mucus, making breathing difficult.
Other Non-Infectious Conditions Often Confused with Infections
Asthma
A long-term lung condition where the airways get inflamed and narrow. Triggered by cold air, dust, pollen, smoke, or stress.Allergies
An immune system overreaction to substances like dust, food, or animal hair. Often causes sneezing, rashes, or breathing trouble.COPD (Chronic Obstructive Pulmonary Disease)
Usually seen in adults, it involves long-term breathing problems due to damage in the lungs. Often caused by smoking or pollution.Cardiac Asthma
Not true asthma. A condition where heart problems cause fluid buildup in the lungs, leading to wheezing.Foreign Body Aspiration
When a child inhales a small object (like a peanut or toy), it can block the airway and cause wheezing.
These conditions are generally non-bacterial and may not benefit from antibiotics unless there is a confirmed co-existing infection.
A Brief Summary of Wheezing and Asthma
Wheezing is a high-pitched whistling sound while breathing, usually due to narrowed airways—comparable to restricted airflow in a blocked passage, similar to a water pump experiencing air lock
Asthma is the underlying cause in most cases, especially when wheezing is frequent or triggered by cold, dust, or exercise. It can start in childhood and persist into adulthood if not treated properly.
The Misuse of Steroids in Children
Steroids are often used to reduce airway inflammation and provide quick relief from wheezing. But frequent use in young children and adolescents may carry risks and should ideally be limited to medically justified situations.
My View and a Self-Experience Caution
As a medical researcher, I question the appropriateness of this practice in younger patients, especially when safer or longer-term strategies could be considered first.
Why This Is Concerning
Steroids come with many serious side effects, including:
Suppressed immune system
Stiffening or contraction of lung tissues
Delayed growth in children
Increased risk of infections
Hormonal imbalance
Weakening of bones (osteoporosis) with long-term use
Parents may notice quick relief after steroid use, but they often don’t realize the long-term harm it can cause.
Adenoids and Their Role in Wheezing
Enlarged adenoids (the soft tissue at the back of the nose) can block airways and lead to mouth breathing, snoring, and even wheezing. In some children, removing or treating the enlarged adenoids greatly improves breathing and reduces wheezing episodes.
In children with frequent nasal blockage or nighttime breathing issues, evaluating adenoid size may provide useful insights into recurrent wheezing or breathing discomfort.
Can Wheezing Be Cured Permanently?
In many cases, wheezing can be significantly reduced—and in some, potentially resolved—through a combination of lifestyle, clinical, and preventive strategies such as :
Identify and avoid triggers like cold air, dust, smoke, strong perfumes, and pets
Strengthen lungs through regular physical activity and breathing exercises
Check for adenoid enlargement and treat if necessary
Focus on good nutrition to support immunity
Avoid overuse of medications, especially steroids and antibiotics, unless absolutely necessary
Why Do Doctors Prescribe Antibiotics When Wheezing Isn’t Caused by Bacteria?
Despite wheezing often being non-bacterial, some doctors prescribe antibiotics based on precautionary reasoning or resource limitations such as :
To Rule Out or Cover Secondary Infections
Children with wheezing may also have cough, cold, or mild fever. Doctors may suspect an early bacterial infection (like bronchitis or pneumonia), so they prescribe antibiotics “just in case.”
Pressure for Quick Relief
Parents expect fast results. To avoid repeat visits or worsening, doctors often choose an aggressive approach.
Lack of Proper Diagnostic Tools in Small Clinics
Many small clinics don’t have access to rapid tests or imaging, so doctors err on the side of caution and prescribe antibiotics.
Prevention of Hospitalization
In severe wheezing cases, doctors may resort to a combination of treatments—including antibiotics, nebulizers, and steroids—as part of an effort to prevent emergency escalation.
FINAL THOUGHTS
Doctors are not always wrong—in emergencies, they must act quickly. But the bigger issue is this:
There is concern about the overuse of these medications, especially in non-emergency settings where alternative management strategies may be more appropriate
There’s not enough focus on long-term care, lifestyle adjustments, allergen control, or root causes like adenoids and air quality
