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Early treatment in preschool children: an evidence-based approach
Sheharyar Durrani1, Theresa W Guilbert
1aDivision of Pulmonology Medicine bDivision of Allergy, Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA.
Insights
Diagnosing and treating asthma in young children is challenging. Key factors for childhood asthma include genetics, allergies, and infections, managed with inhaled corticosteroids and leukotriene-receptor antagonists.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Epidemiology
Background:
- Wheezing is common in early childhood, but persistent symptoms present diagnostic challenges.
- Identifying children with asthma in preschool years is crucial for timely intervention.
Purpose of the Study:
- To review recent findings on the epidemiology, diagnosis, evaluation, and treatment of preschool-aged children with asthma.
- To provide insights into managing persistent wheezing in early childhood.
Main Methods:
- Literature review of recent studies on preschool asthma.
- Analysis of epidemiological data, diagnostic criteria, and therapeutic approaches.
Main Results:
- Childhood asthma predictors include male sex, respiratory infections, parental asthma, atopic dermatitis, eosinophilia, and early sensitization.
- Preschool asthma is often exacerbation-prone with limited impairment, diagnosed via symptoms, risk factors, and treatment response.
- Management involves inhaled corticosteroids, leukotriene-receptor antagonists, and sometimes combination therapies.
Conclusions:
- Asthma diagnosis in preschoolers relies on symptom patterns and risk factors.
- Effective asthma management requires family-healthcare team partnership and regular assessment.
- Controller therapies are essential for managing asthma symptoms in young children.
Purpose Of Review:
Wheezing is a common symptom in early childhood but only some of these children will experience continued wheezing symptoms in later childhood making the diagnosis and treatment of these children challenging. This review covers recent findings regarding the epidemiology, diagnosis, evaluation, and treatment of preschool-aged children with asthma.
Recent Findings:
Key characteristics that distinguish the childhood asthma-predictive phenotype include male sex, history of wheezing with lower respiratory tract infections, history of parental asthma, history of atopic dermatitis, eosinophilia, early sensitization to food or aeroallergens, or lower lung function in early life. The preschool-aged asthma population tends to be characterized as exacerbation prone with relatively limited impairment. The diagnosis of asthma in preschool-aged children is often based on symptom patterns, presence of risk factors, and therapeutic responses. Asthma management includes intermittent and daily inhaled corticosteroids, daily leukotriene-receptor antagonists, and, in rare cases, combination therapies.
Summary:
The diagnosis of asthma in preschool-aged children is based on symptom patterns and the presence of risk factors, and the goals of asthma management are achieved through a partnership between the family and the healthcare team using regular assessment of symptom control and response to daily controller therapy.
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