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Which Wheezing Preschoolers Should be Treated for Asthma?
Leonard B Bacharier1, Theresa W Guilbert2, Tuomas Jartti3
1Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn.
Summary
Identifying which young children with asthma need treatment is challenging. This review offers a practical approach using symptom assessment and biomarkers to guide treatment decisions for preschoolers with recurrent wheezing.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Allergy and Immunology
Background:
- Wheezing disorders are common in children under 5, but treatment guidelines are unclear.
- Deciding on appropriate interventions for preschool asthma remains a clinical challenge.
Purpose of the Study:
- To provide a practical framework for managing asthma in children under 5.
- To guide the selection of treatment strategies for preschoolers with recurrent wheezing.
Main Methods:
- Review of current literature on preschool asthma diagnosis and management.
- Emphasis on defining asthma based on symptoms, not underlying mechanisms.
- Inclusion of objective biomarkers like aeroallergen sensitization and blood eosinophils.
Main Results:
- A structured approach to preschool asthma management is proposed.
- Assessment should integrate symptom characteristics, timing, severity, and biomarkers.
- Highlights gaps in knowledge regarding nonallergic preschool wheezing.
Conclusions:
- A clear definition of asthma in preschoolers is crucial.
- Biomarker assessment aids in treatment decisions for recurrent wheezing.
- Further research is needed for optimal management of nonallergic preschool asthma.
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