- Meeting abstract
- Open Access
Italian Journal of Pediatrics volume 41, Article number: A64 (2015)
Pediatricians face many challenges when diagnosing wheezing in preschool children. These diagnostic challenges are compounded by variations in the natural history of early stage asthma, which are not fully understood, since early childhood wheezing and asthma are heterogeneous disorders with many phenotypic and variable expressions. Several risk factors related to genetic, prenatal, and postnatal environment are associated with preschool wheezing. Findings from cohort studies have shown that preschool children with wheeze have deficits in lung function at 6 years of age that persisted until early and middle adulthood, suggesting increased susceptibility in the first years of life that might lead to persistent sequelae .
Since no standard definition for the type, severity, or frequency of symptoms exist for this age group, clear evidence-based recommendations are lacking. Without adequate guidance, pediatricians are left to make diagnostic and treatment decisions, which can lead to undertreatment of asthmatics and overtreatment of transient wheezers. New guidelines and/or Consensus documents that specifically address the challenges of diagnosing asthma in this particular age group have recently been published, and researchers are actively seeking new methods and techniques through epidemiological studies to assist primary care clinicians in the diagnostic process [2–5].
Treatment of young children with asthma remains poorly defined and very controversial. A study has described the prescribing patterns among primary care physicians in Italy, and concluded that child characteristics alone are not sufficient to explain how physicians decide to prescribe maintenance treatment and which specific therapy to assign . Daily inhaled corticosteroids seem to be the most effective therapy for recurrent wheezing in trials of children with interim symptoms or atopy. Intermittent high-dose inhaled corticosteroids are effective in moderate-to-severe viral-induced wheezing without interim symptoms. However, the role of corticosteroids in treating acute asthma in young children has been questioned, is currently being carefully evaluated, and requires evidence-based directions [7–9]. The role of leukotriene receptor antagonist is less clear, and should hopefully be evaluated further in larger study groups . Interventions to modify the short-term and long-term outcomes of preschool wheeze should be a research priority.
Stein RT, Martinez FD: Asthma phenotypes in childhood: lessons from an epidemiological approach. Paediatr Respir Rev. 2004, 5 (2): 155-161. 10.1016/j.prrv.2004.01.007.
Global Initiative for Asthma Report: Global strategy for asthma management and prevention. 2014, Available at: http://www.ginasthma.org. Accessed May 11, 2015
British Thoracic Society, Scottish Intercollegiate Guidelines Network: British guideline on the management of asthma: a national clinical guideline. Available from: https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-guideline-on-the-management-of-asthma/. Accessed May 11, 2015
Brand PL, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, et al: Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J. 2008, 32 (4): 1096-1110. 10.1183/09031936.00002108.
Brand PL, Caudri D, Eber E, Gaillard EA, Garcia-Marcos L, Hedlin G, et al: Classification and pharmacological treatment of preschool wheezing: changes since 2008. Eur Respir J. 2014, 43 (4): 1172-1177. 10.1183/09031936.00199913.
Montella S, Baraldi E, Bruzzese D, Mirra V, Di Giorgio A, Santamaria F, et al: What drives prescribing of asthma medication to preschool wheezing children? A primary care study. Pediatr Pulmonol. 2013, 48 (12): 1160-1170. 10.1002/ppul.22761.
Weinberger M: The challenge of treating preschool asthma. J Allergy Clin Immunol. 2014, 133 (4): 1014-1015. 10.1016/j.jaci.2013.07.013.
Beigelman A, Zeiger RS, Kelly HW, Bacharier LB, Childhood Asthma Research and Education Network of the National Heart, Lung and Blood Institute: The challenge of treating preschool wheezing episodes: the need for evidence-based approaches. J Allergy Clin Immunol. 2014, 133 (4): 1016-1017. 10.1016/j.jaci.2014.01.005.
Miller EK, Avila PC, Khan YW, Word CR, Pelz BJ, Papadopoulos NG, et al: Wheezing exacerbations in early childhood: evaluation, treatment, and recent advances relevant to the genesis of asthma. J Allergy Clin Immunol Pract. 2014, 2 (5): 537-543. 10.1016/j.jaip.2014.06.024.
Pelkonen AS, Malmström K, Sarna S, Kajosaari M, Klemola T, Malmberg LP, et al: The effect of montelukast on respiratory symptoms and lung function in wheezy infants. Eur Respir J. 2013, 41 (3): 664-670. 10.1183/09031936.00173411.
About this article
Cite this article
Santamaria, F. Preschool wheezing. Ital J Pediatr 41, A64 (2015). https://doi.org/10.1186/1824-7288-41-S2-A64
- Primary Care
- Primary Care Physician
- Preschool Child