Clinical Profile of Episodic Wheezing and Multiple Trigger Wheezing in Preschool Children: A Cross-Sectional Study

Venkatesh Chandrasekaran,Lalsiama Tualzik

doi:10.1055/s-0040-1717140

Abstract

AbstractThe objectives of our study were to identify the relative frequency of episodic viral wheeze (EVW) and multiple trigger wheeze (MTW) in preschool children of 1 to 5 years of age with recurrent wheezing and to compare the relevant clinical and sociodemographic parameters in the above phenotypes. This cross-sectional study included 165 children aged 1 to 5 years with recurrent wheeze. Participants were categorized into EVW and MTW based on history according to European Respiratory Society Task Force recommendations 2008. Symptom control was assessed by Global Initiative for Asthma guidelines 2015. Of the total participants, EVW was seen in 55% and MTW in 45%. Children with MTW were significantly older than those with EVW, more atopic, and had higher eosinophil counts. The dominant phenotype seen in our study was EVW. The absence of ocular/nasal allergy and exclusive breastfeeding predicted well-controlled symptoms in EVW and in all preschool wheezers, respectively.

Highlights

Preschool wheezers are twice more likely to visit hospitals and thrice more likely to be admitted compared with older children.1 An essential requirement for better management of these children is to classify them as either episodic viral wheezers (EVWs) or multiple trigger wheezers (MTWs) based on European Respiratory Society (ERS) Task Force recommendations 2008.2 these phenotypes were found by some authors to change over time,3–5 a recent study by Spycher et al indicates that they remain stable.6 A significant number of them, the MTW, are likely to have symptoms consistent with asthma and reduced lung capacity later in life.7,8 The identification of these phenotypes help in predicting long-term outcomes and to identify high-risk children who might benefit from secondary preventive interventions
The number of children on montelukast was higher in EVW group; those on inhaled corticosteroids (ICSs) were higher in MTW group and this finding was statistically significant
Atopy is more often associated with MTW, in our study, we found they may be associated with EVW and further serves to support the observations of the ERS Task Force statement that there may be overlap between the two phenotypes

Summary

Introduction

Preschool wheezers are twice more likely to visit hospitals and thrice more likely to be admitted compared with older children. An essential requirement for better management of these children is to classify them as either episodic viral wheezers (EVWs) or multiple trigger wheezers (MTWs) based on European Respiratory Society (ERS) Task Force recommendations 2008.2 these phenotypes were found by some authors to change over time, a recent study by Spycher et al indicates that they remain stable. A significant number of them, the MTW, are likely to have symptoms consistent with asthma and reduced lung capacity later in life. The identification of these phenotypes help in predicting long-term outcomes and to identify high-risk children who might benefit from secondary preventive interventions. A significant number of them, the MTW, are likely to have symptoms consistent with asthma and reduced lung capacity later in life.. A significant number of them, the MTW, are likely to have symptoms consistent with asthma and reduced lung capacity later in life.7,8 The identification of these phenotypes help in predicting long-term outcomes and to identify high-risk children who might benefit from secondary preventive interventions. There are only few studies comparing the clinical and sociodemographic profiles of these two phenotypes and none among Indian children. This study was performed to identify the relative frequency of EVW and MTW in preschool children 1 to 5 years of age with wheezing and to compare the relevant clinical and sociodemographic parameters in the above phenotypes

Objectives

Methods

Results

Discussion

Conclusion