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Phenotype-Based Management of Recurrent Preschool Wheezing and Asthma
Sejal Saglani1, Anne M Fitzpatrick2, Nikolaos G Papadopoulos3
1National Heart & Lung Institute and Centre for Paediatrics & Child Health, Imperial College London, London, United Kingdom.
Insights
Preventing acute wheezing episodes in preschool children requires personalized therapy. Accurate phenotyping and biomarker identification are key to tailoring treatments and improving long-term respiratory health outcomes.
Area of Science:
- Pediatric Pulmonology
- Clinical Medicine
Background:
- Acute wheezing is a common cause of unscheduled healthcare visits in preschool children, with increasing incidence.
- Current management strategies for preschool wheeze are suboptimal, leading to persistent morbidity and poor long-term health trajectories.
- Recurrent exacerbations impact lung function development and increase risks for adult respiratory and cardiovascular diseases.
Purpose of the Study:
- To review evidence for managing recurrent preschool wheeze to prevent acute episodes.
- To highlight the importance of accurate clinical phenotyping in guiding treatment decisions.
- To emphasize the need for biomarker discovery to personalize therapy for preschool wheeze.
Main Methods:
- Systematic review of existing literature on preschool wheeze management.
- Analysis of current approaches to phenotyping and treatment selection.
- Discussion of the role of biomarkers in personalized medicine for pediatric respiratory conditions.
Main Results:
- Preschool wheeze is a heterogeneous condition with distinct phenotypes and pathophysiological mechanisms.
- Accurate phenotyping is crucial for effective management and prevention of acute episodes.
- Biomarker identification can guide individualized treatment strategies for better therapeutic response.
Conclusions:
- A personalized therapy approach, guided by precise phenotyping and biomarkers, is essential for managing recurrent preschool wheeze.
- This tailored approach promises improved symptom control and reduced healthcare burden.
- Implementing personalized medicine can mitigate long-term respiratory and cardiovascular morbidity in affected children.
Abstract:
Acute wheezing episodes in preschool children are among the most common reason for unscheduled health care attendance globally, and the incidence of acute presentations has increased over the past 2 decades. Although it is recognized that wheezing disorders in preschool children are heterogeneous, incorporating several phenotypes, with distinct underlying pathophysiological mechanisms, the continuing morbidity suggests our current approach to preventing acute episodes is suboptimal. Recurrent wheeze exacerbations and poor symptom control contribute to a low lung function trajectory to adulthood and increased mortality and morbidity later in life from both respiratory and cardiovascular conditions. Effective treatment strategies to reduce acute exacerbations and improve symptom control are needed to prevent these poor long-term outcomes. The focus of this review was to summarize the evidence for the management of recurrent preschool wheeze to prevent acute episodes, emphasizing the importance of both accurate clinical phenotyping and the need to undertake investigations to identify biomarkers that can be used to guide treatment choice best suited to the child's phenotype. This approach will enable a move toward more personalized therapy, which may have a better response than our current approach, and allow us to reduce the health care burden and morbidity resulting from recurrent preschool wheeze.
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