Abstract
Wheezing is very common in infancy affecting one in three children during the first 3 years of life. Several wheeze phenotypes have been identified and most rely on temporal pattern of symptoms. Assessing the risk of asthma development is difficult. Factors predisposing to onset and persistence of wheezing such as breastfeeding, atopy, indoor allergen exposure, environmental tobacco smoke and viral infections are analyzed. Inhaled corticosteroids are recommended as first choice of controller treatment in all preschool children irrespective of phenotype, but they are particularly beneficial in terms of fewer exacerbations in atopic children. Other therapeutic options include the addition of montelukast or the intermittent use of inhaled corticosteroids. Overuse of inhaled steroids must be avoided. Therefore, adherence to treatment and correct administration of the medications need to be checked at every visit.
Highlights
In preschool children, wheezing is very heterogeneous and evidence on pathophysiology and treatment is scant [1]
In the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, two more phenotypes were identified at 9 years of age [9, 16]: (a) prolonged early wheeze group, not associated with airborne allergen sensitization and weakly associated with higher airway responsiveness and impaired lung function; (b) intermediateonset wheeze group with persisting symptoms, atopy, poor lung function and at more risk of developing asthma in childhood
It has been shown that asthma that remains over time and severe asthma attacks are more common in children with food allergy and depends on number of offending foods [47]. These findings suggest that it may be worthwhile to perform skin prick tests to foods in patients with wheezing and/or atopic eczema [48]
Summary
In preschool children, wheezing is very heterogeneous and evidence on pathophysiology and treatment is scant [1]. Preschool wheezing should be considered an umbrella term for distinctive diseases with different observable and measurable features (phenotypes). Each phenotype may be the result of different endotypes, described by a mechanism that links clinical features with a molecular pathway. Different approaches have been used in the search of wheezing phenotypes. The selection of observable variables can be driven by the investigator or by data. The design can be cross-sectional or longitudinal. We discuss knowledge on expression of preschool wheezing phenotypes and their value regarding outcomes, prognosis and long-term treatment
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