Basic clinical management of preschool wheeze

Abstract

Preschool wheeze is very common and often difficult to treat. Most children do not require any investigations; only a detailed history and physical examination to ensure an alternative diagnosis is not being missed; and the differential diagnosis, and hence investigation protocols for the child in whom a major illness is suspected, shows geographical variation. The pattern of symptoms may be divided into episodic viral and multiple trigger to guide treatment, but the pattern of symptoms must be re‐assessed regularly. However, symptom patterns are a poor guide to underlying pathology. Attention to the proper use of spacers, and adverse environmental exposures such as tobacco smoke exposure, is essential. There are no disease‐modifying therapies, so therapy is symptomatic. This paper reviews recent advances in treatment, including new data on the place of leukotriene receptor antagonists, prednisolone for acute attacks of wheeze, and antibiotics, based on new attempts to understand the underlying pathology in a way that is clinically practical.

Prevalence of Wheezing and Its Association with Environmental Tobacco Smoke Exposure among Rural and Urban Preschool Children in Mpumalanga Province, South Africa

“…(Asthma Ever) (7) Did a physician or nurse diagnose the asthma? (8) Has your child's chest ever made a wheezy noise while playing or right after? (9) Besides from a cough brought on by a cold or chest illness, has your child experienced a cough that is dry at night in the last 12 months?…”

“…Preschool wheezing is a common condition, and environmental tobacco smoke (ETS) exposure is a significant risk factor for wheezing in preschool children [6][7][8]. ETS possess comparable toxic components to those found in conventional tobacco smoke, consequently 2 of 20 resulting in similar detrimental consequences akin to those observed in individuals who engage in active smoking [9].…”

From preschool wheezing to asthma: Determinants

“…After excluding any potential mimickers of wheezing or asthma, the author highlights the importance of evaluating the child's "treatable traits" and selecting the appropriate treatment strategy. 10…”

“…In a subsequent review in the journal, Bush evaluates the evidence on appropriate management of preschool‐aged children with recurrent wheezing with a focus on evidence‐based strategies. After excluding any potential mimickers of wheezing or asthma, the author highlights the importance of evaluating the child's “treatable traits” and selecting the appropriate treatment strategy 10 …”