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

Abstract

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.

Functional Lung Examination in Diagnostics of Asthma and Its Phenotypes

“…The limitation of this approach comes from the fact that it can be set only retrospectively and thus it is of little clinical impact. Later, another classification of early wheeze has been suggested by a European Respiratory Society task force-a dichotomy based on trigger factors: episodic viral wheeze and multiple-trigger wheeze [3]. Besides the time-and symptom-based approaches, there exist many other phenotypes, which have been adopted from adults: allergic asthma, nonallergic asthma, asthma with fixed airflow limitation, asthma with obesity, and so on.…”

Potential Role of Serum Periostin in the Early Detection of Bronchial Asthma in Children

“…При проспективном наблюдении [58] установ-лено, что симптомы одышки и свистящего дыхания при острой респираторной вирусной инфекции встречаются в среднем у 33% детей до 3-летнего возраста и у 50% -до 6 лет. У большинства таких детей к шести годам эпизоды свистящего дыхания проходят, и только у 1 (!)…”

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…31,32 The common clinical scenario of 'wheezy infants' poses a particular challenge for primary care. The diagnosis is based on the history, signs and symptoms, 33,34 and whilst the presence of atopy may strengthen the probability of asthma, diagnostic spirometry is not practical under the age of 5 years. 35 The IPCRG guidelines suggest a range of symptom-based tools and investigations including peak flow monitoring, spirometry, reversibility testing and challenge tests, 36 and a recent international statement summarises the technical details.…”

“…Children and adults may have persistent or episodic asthma, triggered by viral infections, allergens or exercise. 12,33 Asthma in pregnancy requires proactive management to optimise outcomes for mother and baby. 14 Asthma and rhinitis often co-exist in the same patient.…”