Lung function testing and inflammation markers for wheezing preschool children: A systematic review for the EAACI Clinical Practice Recommendations on Diagnostics of Preschool Wheeze

Abstract

Background: Preschool wheeze is highly prevalent; 30%-50% of children have wheezed at least once before age six. Wheezing is not a disorder; it is a symptom of obstruction in the airways, and it is essential to identify the correct diagnosis behind this symptom. An increasing number of studies provide evidence for novel diagnostic tools for monitoring and predicting asthma in the pediatric population. Several techniques are available to measure airway obstruction and airway inflammation, including spirometry, impulse oscillometry, whole-body plethysmography, bronchial hyperresponsiveness test, multiple breath washout test, measurements of exhaled NO, and analyses of various other biomarkers. Methods: We systematically reviewed all the existing techniques available for measuring lung function and airway inflammation in preschool children to assess their potential and clinical value in the routine diagnostics and monitoring of airway obstruction. Results: If applicable, measuring FEV1 using spirometry is considered useful. For those unable to perform spirometry, whole-body plethysmography and IOS may be useful. Bronchial reversibility to beta2-agonist and hyperresponsiveness test with running exercise challenge may improve the sensitivity of these tests. Conclusions: The difficulty of measuring lung function and the lack of large randomized controlled trials makes it difficult to establish guidelines for monitoring asthma in preschool children.

Use of Impulse oscillometry for Diagnostic of Asthma in Preschoolers: A Cost-effectiveness Analysis

“…Our results are in line with the recent recommendations of European Academy of Allergy and Clinical Immunology (EAACI) Task Force for Clinical Practice Recommendations on Preschool Wheeze. This task force recognizes that IOS may be a useful tool in diagnosing asthma in preschool children; particularly for children unable to perform spirometry (17) . It is a diagnostic test simple, non-invasive, and effortless method requiring minimal patient cooperation for lung function measurement, useful to documenting response to bronchodilators and distinguishing between healthy and wheezing children (5).…”

Small airway dysfunction is an independent dimension of wheezing disease in preschool children

“…1 Lung function measurement is an essential tool in the differential diagnosis of preschool wheezing, although reliable lung function measurements are challenging in this age group and the diagnostic value of functional tests remains debated. 1 This issue is important given the possible underestimation of asthma prevalence in preschool children. 2 On the contrary, wheeze has been associated with prescriptions of asthma medications in young children, which could lead to an inappropriate and too high prescription rate of inhaled corticosteroids.…”

“…In a recent systematic review of the European Academy of Allergy and Clinical Immunology, the Clinical Practice Recommendations on Diagnostics of Preschool Wheeze stated that it is difficult to establish guidelines for monitoring asthma in preschool children. 1 Lung function measurement is an essential tool in the differential diagnosis of preschool wheezing, although reliable lung function measurements are challenging in this age group and the diagnostic value of functional tests remains debated. 1 This issue is important given the possible underestimation of asthma prevalence in preschool children.…”

Small airway dysfunction is an independent dimension of wheezing disease in preschool children

“…In a recent systematic review for the European Academy of Allergy and Clinical Immunology, the clinical practice recommendations on diagnostics of preschool wheeze stated that it is difficult to establish guidelines for monitoring asthma in preschool children. (1) Lung function measurement is an essential tool in the differential diagnosis of preschool wheezing, although reliable lung function measurements are challenging in this age group and the diagnosis value of functional tests remains debated. (1) This issue is important given the possible underestimation of asthma prevalence in preschool children.…”

“…(1) Lung function measurement is an essential tool in the differential diagnosis of preschool wheezing, although reliable lung function measurements are challenging in this age group and the diagnosis value of functional tests remains debated. (1) This issue is important given the possible underestimation of asthma prevalence in preschool children. (2) On the other hand, wheeze has been associated with prescriptions of asthma medications in young children, which could lead to inappropriate and too high prescription rate of inhaled corticosteroids.…”