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Demystifying controversies in preschool wheeze.
Frank M Smith1, Sejal Saglani1,2,3
1Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.
Expert Review of Respiratory Medicine
|November 18, 2023
Summary
Preschool wheezing disorders are diverse, not a one-size-fits-all condition. Effective management requires identifying specific phenotypes rather than relying on standard corticosteroid treatments for all children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Preschool wheezing is common, but current treatments often assume uniformity.
- Standard approaches use oral corticosteroids (OCS) for acute attacks and inhaled corticosteroids (ICS) for maintenance, despite variable patient response.
- Increasing evidence highlights significant heterogeneity in preschool wheezing disorders.
Approach:
- This review clarifies pathophysiological concepts in preschool wheezing.
- It aims to demystify controversies surrounding these conditions and improve management strategies.
- The focus is on understanding the variability in corticosteroid response based on disease severity and phenotype.
Key Points:
- Preschool wheezing differs from school-age allergic asthma.
- Limited evidence supports routine OCS use for acute preschool wheezing attacks.
- Objective tests are crucial for diagnosing phenotypes before initiating maintenance therapy.
Conclusions:
- A staged diagnostic approach is essential for preschool wheezing.
- Identifying the pathological phenotype guides effective symptom control and attack prevention.
- Personalized treatment strategies are necessary due to the heterogeneity of preschool wheezing disorders.
Keywords:
Allergic sensitizationdiagnosiseosinophilsinfectionmanagementneutrophilsphenotypepreschool wheezeMore Related Videos
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