The American Thoracic Society has published guidelines to help clinicians evaluate infants with recurrent or persistent wheezing that is not responding to treatment with bronchodilators or corticosteroids. 

“Although infantile wheezing is very common, there is a paucity of evidence to guide clinicians in selecting diagnostic tests for recurrent or persistent wheezing” the committee wrote.

The guidelines committee group involved 19 clinical and research experts who reviewed the literature on diagnostic tests that were viewed as either specialised or controversial. 

 For infants younger than 24 months with persistent wheezing despite treatment with bronchodilators, inhaled corticosteroids, or systemic corticosteroids the authors suggested:

• an airway survey via flexible fiberoptic bronchoscopy,
• bronchoalveolar lavage,
• 24-hour esophageal pH monitoring rather than upper gastrointestinal radiography,
• 24-hour esophageal pH monitoring rather than gastrointestinal scintigraphy, and
• video-fluoroscopic swallowing studies.

In infants who do not have eczema but have persistent wheezing despite treatments with bronchodilators, inhaled corticosteroids, or systemic corticosteroids, the authors recommended against empiric food avoidance or dietary changes. They did recommend, however, that research studies be conducted among these infants to determine if dietary changes help.

You can access the full guidelines here.