An Approach to Preschool Wheezing: To Label As Asthma?

Abstract

Asthma is considered a chronic disease, but not all preschool wheezing is asthma since most will eventually grow out of their symptoms. Although still a matter of debate, preschool wheezing can be classified in 2 major groups: virus-induced wheezing and multitrigger wheezing, having a different prognosis and a different treatment approach. Virus-induced wheezing is the most common phenotype of preschool wheezing and is usually associated with a good prognosis. Treatment should be conservative, but if preventive treatment is required, leukotriene-receptor antagonists might be the first choice treatment. Multitrigger wheezing is associated with an allergic disposition and has a higher risk of persistent symptoms. Inhaled corticosteroids may give short-term reduction in exacerbations, but the beneficial effect of long-term use of inhaled corticosteroids and other anti-inflammatory agents have not yet been established. This review aims to give an opinion on preschool wheezing, and its association with asthma.

Qualitative study of practices and challenges when making a diagnosis of asthma in primary care

“…Meanwhile, in adults, participants worried about conditions such as COPD, echoing widely expressed views. 20–22 Contemporary understanding of ‘the asthmas’ is moving towards considering asthma as an initial description, which is then refined into phenotypes with different disease trajectories, and underlying airway inflammation. 23,24 The future of asthma diagnosis (at least in resource-rich settings) may therefore move away from the label of ‘asthma’ to delineating phenotypes or ‘treatable traits’ requiring additional tests (such as FeNO).…”

Lactobacillus rhamnosus GG in the Primary Prevention of Eczema in Children: A Systematic Review and Meta-Analysis

“…However, not all cases of early life wheezing will progress into asthma later on. Most children will eventually grow out of the symptoms and will never develop asthma [ 23 ]. Regardless, as some trials have indicated an increased risk of wheezing/asthma, more data are needed to evaluate this potentially harmful effect of using probiotics.…”

Prevalence and associated factors of wheezing illnesses of children aged three to five years living in under-served settlements of the Colombo Municipal Council in Sri Lanka: a cross-sectional study

“…Though some researchers have used a modified version of the ISAAC questionnaire adapted to the preschool age and study setting [ 28 ], its validity is not well researched. Furthermore, the present study did not consider preschool wheezing as the same entity as asthma as there is lack of chronicity which is expected in asthma [ 6 ]. Moreover, inflammatory reactions in preschool aged children have been shown to be different from those observed in older children with diagnosed asthma [ 29 ].…”

“…As there is an observed increase in prevalence in areas where prevalence was previously low, the global burden of asthma and wheezing, however, continues to increase [ 1 – 3 ]; with the most significant increase noted among children between one to five years [ 4 , 5 ]. Due to difficulties in demonstrating airflow limitation [ 6 , 7 ] in young children, it is recommended to avoid the term ‘asthma’ in preschoolers with wheezing and airway inflammatory reactions and to use the term ‘wheezing illnesses’ instead [ 6 , 8 ]. Wheezing illnesses affect the health, wellbeing and quality of life of the affected, impose a substantial burden on the family and the healthcare system, and can be particularly troublesome to diagnose and treat, especially when occurring in younger children [ 9 – 12 ].…”