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Episodic viral wheeze and multiple-trigger wheeze in preschool children are neither distinct nor constant patterns. A

Maud J A Raaymakers1, Paul L P Brand2,3, Anneke M Landstra4

  • 1Department of Pediatrics, Amphia Hospital, Breda, The Netherlands.

Pediatric Pulmonology
|June 19, 2019
PubMed

Insights

Episodic viral wheeze (EVW) and multiple-trigger wheeze (MTW) phenotypes in preschoolers are not clinically distinct or stable. Pediatrician assessments of wheeze phenotypes often differ from actual symptom patterns, questioning their clinical utility.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Clinical Phenotyping

Background:

  • Wheezing in preschoolers is often categorized into episodic viral wheeze (EVW) and multiple-trigger wheeze (MTW).
  • The clinical distinguishability and stability of these preschool wheezing phenotypes are not well-established.
  • Accurate phenotyping is crucial for guiding treatment and prognosis in pediatric respiratory conditions.

Purpose of the Study:

  • To determine if episodic viral wheeze (EVW) and multiple-trigger wheeze (MTW) are clinically distinguishable preschool wheezing phenotypes.
  • To assess the stability of EVW and MTW phenotypes over time in young children.
  • To compare prospective symptom diary data with pediatrician-based clinical history for wheeze phenotyping.

Main Methods:

  • Recruited 189 children aged 1-4 years with recurrent wheeze.
  • Parents prospectively recorded respiratory and viral upper respiratory tract infection (URTI) symptoms weekly via electronic diary for 12 months.
  • Diary-based phenotypes (EVW/MTW) were compared with pediatrician-assigned phenotypes, with viral PCR analysis performed.

Main Results:

  • Diary-based phenotypes showed low agreement with pediatrician assessments (Kappa=0.12).
  • Significant phenotypic instability was observed in 32% of cases over the study period.
  • Viral PCR was positive in a substantial proportion of children even in the absence of symptoms.

Conclusions:

  • Episodic viral wheeze (EVW) and multiple-trigger wheeze (MTW) are variable and unstable phenotypes within individual preschool children.
  • Pediatrician classification based on clinical history does not reliably reflect prospectively recorded symptom patterns.
  • The clinical utility of current EVW and MTW phenotypes for therapeutic decisions and prognosis in preschool wheeze should be re-evaluated.
Abstract

Keywords:
asthma & early wheezeepisodic viral wheezemultiple-trigger wheezepreschool children

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