Preschool Wheeze is Not Asthma: A Clinical Dilemma - Correspondence.

Abstract

To the Editor: The article entitled ‘Preschool wheeze is not asthma: a clinical dilemma’ has highlighted the management issues based on the available data [1]. Wheeze is common in preschool children and it has evoked lot of interest among researchers and an equal amount of confusion among practitioners. The fact that the incidence of all preschool wheezing disorders has increased (including viral wheeze) makes it probable that factors unrelated to atopy are implicated in the changing epidemiology of wheeze in childhood [2]. Young children who present with symptoms of wheeze may either have viral-associated respiratory problems that may not persist into later childhood or may have an asthmatic pattern of airway inflammation that may subsequently develop into asthma [3]. Results from longitudinal studies indicate that the term Basthma^ includes different phenotypes: Tucson birth cohort study identified three phenotypes of childhood wheezing, namely transient early wheezing, nonatopic wheezing, and persistent ‘atopic’ wheezing [4]. The best way to discriminate phenotypes in young children is yet to be found. European Task Force has proposed 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 these discrete episodes [5]. Phenotype-specific treatment has been recommended even though phenotypes are not mutually exclusive [6]. Whether early childhood wheezing and asthma represent the ends of a spectrum of a single entity or they represent two distinct heterogeneous disorders is a subject of long debate. There are two groups of articles appearing in journals, few stressing the importance of preschool wheeze, ignoring the early onset asthma and others concentrating on the management issues of asthma, ignoring the wheezing phenotypes. Since the provisional diagnosis of wheeze plays an important role both from the management and parental appraisal point of view, a proper study validating the above issues is the need of the hour and some consensus should be arrived at, atleast in the issues relating to terminology. Since there are no consensus statements, following suggestions may evoke further discussion on these issues.