Wheezing disorders in preschool children: an evidence-based approach

There is a poor agreement on definitions of different phenotypes of preschool wheezing disorders. The European Respiratory Society (ERS) Task Force proposed to use of the following terms:

- episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes
- multiple-trigger wheeze for children who wheeze both during and outside discrete episodes


Wheezing in Children - Phenotypes (click to enlarge the image).



Childhood asthma phenotypes (click to enlarge the image).

Allergen avoidance may be considered when sensitisation has been established.

Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; however, 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 a preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit.

Large well-designed randomized controlled trials with clear descriptions of patients are needed to improve the present recommendations.

References:

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. P. L. P. Brand et al. ERJ October 1, 2008 vol. 32 no. 4 1096-1110 (free full text).