Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand, P L P; Baraldi, E; Bisgaard, H; Boner, A L; Castro-Rodriguez, J A; Custovic, A; de Blic, J; de Jongste, J C; Eber, E; Everard, M L; Frey, U; Gappa, M; Garcia-Marcos, L; Grigg, J; Lenney, W; Le Souëf, P; McKenzie, S; Merkus, P J F M; Midulla, F; Paton, J Y; ... (2008). Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. European respiratory journal, 32(4), pp. 1096-110. Sheffield, UK: European Respiratory Society 10.1183/09031936.00002108

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There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting beta(2)-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
UniBE Contributor:	Frey, Urs Peter
ISSN:	0903-1936
ISBN:	18827155
Publisher:	European Respiratory Society
Language:	English
Submitter:	Anette van Dorland
Date Deposited:	04 Oct 2013 15:03
Last Modified:	05 Dec 2022 14:19
Publisher DOI:	10.1183/09031936.00002108
PubMed ID:	18827155
Web of Science ID:	000259944500034
URI:	https://boris.unibe.ch/id/eprint/27196 (FactScience: 104934)