Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group

Abstract

Preschool wheezing should be considered an umbrella term for distinctive diseases with different observable and measurable phenotypes. Despite many efforts, there is a large gap in knowledge regarding management of preschool wheezing. In order to fill this lack of knowledge, the aim of these guidelines was to define management of wheezing disorders in preschool children (aged up to 5 years). A multidisciplinary panel of experts of the Emilia-Romagna Region, Italy, addressed twelve different key questions regarding the management of preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes) and systematic reviews have been conducted on PubMed to answer these specific questions, with the aim of formulating recommendations. The GRADE approach has been used for each selected paper, to assess the quality of the evidence and the degree of recommendations. These guidelines represent, in our opinion, the most complete and up-to-date collection of recommendations on preschool wheezing to guide pediatricians in the management of their patients, standardizing approaches. Undoubtedly, more research is needed to find objective biomarkers and understand underlying mechanisms to assess phenotype and endotype and to personalize targeted treatment.

Risk Factors Affecting Development and Persistence of Preschool Wheezing: Consensus Document of the Emilia-Romagna Asthma (ERA) Study Group

“…On the other hand, RSV is the most frequent cause of lower RTI, mainly bronchiolitis, in infants [ 19 ]. Several epidemiological studies demonstrated that a history of severe RSV bronchiolitis is associated with subsequent persistent wheezing, childhood asthma or both [ 10 , 26 ]. RSV infection causes necrosis of the bronchiolar epithelium with subsequent submucosal oedema, recruitment of polymorphonuclear leukocytes and massive release of pro-inflammatory mediators, increased mucus secretion and bronchoconstriction.…”

“…We set up a multidisciplinary panel of experts that included all the Heads of the Paediatric Units of Emilia-Romagna Region, Italy, the Heads of the outpatient clinics for pulmonology and allergology, a sample of primary care paediatricians (identified in each province based on the number of the paediatric population according to ISTAT 2018 data) and a patients’ association (Respiro Libero, Parma, Italy). This study group (named Emilia-Romagna Asthma Study Group and described in detail in a previous publication on the management of children with acute asthma attacks [ 8 ] included members with previous experience in the development of documents and recommendations with the Grading of Recommendations Assessment, Development, and Evaluation [ 9 , 10 ].…”

Critical reappraisal of short-acting bronchodilators for pediatric respiratory diseases

“…Wheezing is an “umbrella” term, including heterogeneous clinical conditions with different respiratory phenotypes. It has been estimated that approximately 50% of children experience at least one wheezing episode before age 6 years [ 18 ].…”

Impact of SARS-CoV-2 Infection in Children with Asthma and Impact of COVID-19 Vaccination: Current Evidence and Review of the Literature

“…Asthma is the most common chronic disease of childhood in the world, and asthma exacerbation is frequently caused by viral infections [ 11 , 12 ]. Initially, asthma patients were classified as an at-risk group for COVID-19 severe forms, but whether asthma has worse COVID-19 consequences is not yet clear [ 13 ].…”