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Published on: May 10, 2024
Current and future management of the young child with early onset wheezing
Allison J Burbank1, Stanley J Szefler
1aUniversity of North Carolina, Chapel Hill, North Carolina bChildren's Hospital Colorado, Aurora, Colorado, USA.
Insights
Predicting asthma progression in young children with recurrent wheezing is possible using tools like the Asthma Predictive Index. Early intervention and personalized treatments are crucial for better outcomes and preventing long-term lung damage.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Recurrent wheezing in preschool children is a common clinical challenge.
- Current guidelines offer a framework for management, but knowledge gaps persist.
- Understanding disease trajectory and treatment efficacy is evolving.
Purpose of the Study:
- To review current guidelines for managing preschool children with recurrent wheezing.
- To identify knowledge gaps and potential future advancements in the next five years.
- To discuss the role of biomarkers and novel therapies.
Main Methods:
- Literature review of current guidelines and research on recurrent wheezing in young children.
- Analysis of diagnostic tools and therapeutic strategies.
- Discussion of emerging treatments and preventative measures.
Main Results:
- Biomarkers such as the Asthma Predictive Index, allergen-specific IgE, eosinophil counts, and exhaled nitric oxide may be underutilized for predicting asthma and treatment response.
- Inhaled corticosteroids and leukotriene receptor antagonists manage symptoms but do not alter disease course.
- Macrolides and monoclonal antibodies show promise but require further trials in younger populations.
Conclusions:
- Phenotyping and endotyping young wheezing children aids in prognostication and treatment selection.
- Primary asthma prevention strategies are essential during early life to prevent irreversible lung function loss.
- Further research is needed to optimize management and prevention in this age group.
Purpose Of Review:
In this review, we discuss current thinking in relation to available guidelines for the care of preschool-aged children with recurrent wheezing, while highlighting the gaps in our knowledge and discussing changes that could occur over the next 5 years.
Recent Findings:
The Asthma Predictive Index as well as allergen-specific IgE, peripheral eosinophil count and exhaled nitric oxide are perhaps underutilized sources of information that can assist in predicting progression to asthma and response to therapies. Inhaled corticosteroids and leukotriene receptor antagonists decrease impairment and exacerbation frequency in wheezing children but are not disease modifying. Macrolides may be useful during acute wheezing episodes for preventing progression to more severe symptoms. Monoclonal antibodies targeting IgE and TH2 cytokines have been successful in trials of adults and older children with asthma, but trials in younger children are needed.
Summary:
Establishing the phenotype and endotype of young wheezing children can be useful for prognostication of future asthma risk as well as for selection of the most appropriate treatment. Primary asthma prevention strategies are needed during the critical developmental window in early life prior to the onset of irrecoverable loss of lung function.
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