Asthma in school-aged children and adolescents

Wildhaber, JH; Sennhauser, FH; Brand, Paul

doi:10.1183/1025448x.00037013

Cited by 4 publications

(4 citation statements)

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“…Most such investigations have been performed in children with severe or unusual clinical features, limiting the generalisability of findings. Both the degree of inflammation and the composition of the infiltrate have been variable, with neutrophils dominating in some studies, eosinophils in others and no evidence of either in others [77]. The only consistent finding was thickening of the reticular basement membrane in wheezy children [77], but not in infants (median age 12 months), even when reversible airflow obstruction and atopy were demonstrated [14].…”

Section: Airway Wall Biopsy and Bronchoalveolar Lavagementioning

confidence: 95%

“…Both the degree of inflammation and the composition of the infiltrate have been variable, with neutrophils dominating in some studies, eosinophils in others and no evidence of either in others [77]. The only consistent finding was thickening of the reticular basement membrane in wheezy children [77], but not in infants (median age 12 months), even when reversible airflow obstruction and atopy were demonstrated [14]. A recent study showed that, by a median age of 29 months, some children with confirmed wheeze exhibit eosinophilic airway inflammation and reticular basement membrane thickening, implying an age window at 12-30 months during which interventions aimed at preventing established airway inflammation might be possible [78].…”

Section: Airway Wall Biopsy and Bronchoalveolar Lavagementioning

confidence: 99%

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Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

European Respiratory Journal

743

759

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There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis.Based on the limited evidence available, inhaled short-acting b 2 -agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop.Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit.Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

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Section: Airway Wall Biopsy and Bronchoalveolar Lavagementioning

confidence: 95%

Section: Airway Wall Biopsy and Bronchoalveolar Lavagementioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

European Respiratory Journal

743

759

View full text Add to dashboard Cite

show abstract

“…Biopsy evidence of inflammation of the airways in young children is scarce and the only consistent biopsy finding in wheezy children is thickening of the basement membrane, 39 but not in infants at median age of 12 months, whereas a study done at mean age 29 months in wheezy children 40 reported eosinophilic airway inflammation and reticular basement membrane thickening, implying an age window during when "inflammation" develops.…”

Section: The Ers Task Force Guidelinesmentioning

confidence: 99%

Current guidelines for the management of asthma in young children

Potter

2010

Allergy Asthma Immunol Res

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The diagnosis and management of asthma in young children is difficult, since there are many different wheezy phenotypes with varying underlying aetiologies and outcomes. This review discusses the different approaches to managing young children with wheezy illnesses presented in recently published global guidelines. Four major guidelines published since 2007 are considered. Helpful approaches are presented to assist the clinician to decide whether a clinical diagnosis of asthma can, or should be made in a young child with a recurrent wheezy illness and which treatments would be appropriate, dependent on risk factors, age of presentation, response to initial treatment and safety considerations. Each of the guidelines provide useful information for clinicians assessing young children with recurrent wheezy illnesses. There are differences in classification of the disease and treatment protocols. Although a firm diagnosis of asthma may only be made retrospectively in some cases and there are several effective guidelines to initiating treatment. Consistent review of the need for ongoing treatment with a particular pharmacological modality is essential, since many children with recurrent wheezing in infancy go into spontaneous remission. It is probable that newer biomarkers of airway inflammation will assist the clinician as to when to initiate and when to continue pharmacological treatment in the future.

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“…However, these studies were performed in those with severe wheezing or with unusual clinical features, which limits the value of the findings. The degrees of inflammation and compositions of the infiltrates were variable, with neutrophils dominating in some studies, eosinophils in others and no evidence of either in the rest [2]. …”

Section: Introductionmentioning

confidence: 99%

An Approach to Preschool Wheezing: To Label As Asthma?

Bever

Han

Chng

et al. 2010

World Allergy Organization Journal

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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.

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Asthma in school-aged children and adolescents

Cited by 4 publications

References 0 publications

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Current guidelines for the management of asthma in young children

An Approach to Preschool Wheezing: To Label As Asthma?

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