Abstract
Preschool wheeze is a common and often difficult to treat symptom. It may rarely be the first presentation of a severe underlying condition. Preschool wheeze is clearly a syndrome, not a single entity, and thus ripe for phenotyping. A number of approaches to phenotyping have been adopted. Epidemiology, based on the temporal patterns of symptoms, has taught us a lot about the medium and long-term implications of early life events, but is not useful for treatment planning. Atopic status is also not useful. Instead, symptom pattern (episodic (viral) and multiple trigger) should be used to decide on treatment. Reduced lung function at birth is associated with a number of maternal factors, including smoking (both by direct and epigenetic mechanisms), atopic status, and pregnancy complications; these children tend to have transient wheeze. Children whose symptoms persist into mid-childhood are born with normal lung function, but have evidence of airflow obstruction at 4–6 years of age. Early atopic sensitization is important in this group. Treatment of pre-school wheeze should be based on relief of present symptoms; there is no known therapy which prevents progression from episodic to multiple trigger symptoms and asthma. Episodic (viral) wheeze is a neutrophilic disease and should be treated with intermittent therapy. Options include inhaled anticholinergics or short-acting β-2 agonists, oral leukotriene receptor antagonists and short-course, high-dose inhaled corticosteroids. Prophylactic inhaled corticosteroids are not useful. Neither prophylactic nor inhaled corticosteroids are effective in preventing progression from an episodic viral to a multiple-trigger pattern. Multipletrigger wheeze may merit a three-step trial (trial period, stop if apparent response, restart only if symptoms return) of prophylactic inhaled corticosteroids or leukotriene receptor antagonists. Recent data have shown that prednisolone should not be a routine treatment for acute exacerbations of episodic (viral) wheeze, but should only be used for really severe excacerbations, defined as being more severe than a routine admission and likely needing high dependency care. This is especially true in the setting of multiple trigger wheeze.
Keywords: asthma, inhaled corticosteroid, leukotriene, neutrophil, prednisolone
Downloads
Download data is not yet available.
Most read articles by the same author(s)
-
Ratko Delić,
Pregnancy in a Unicornuate Uterus with Non-Communicating Rudimentary Horn: Diagnostic and Therapeutic Challenges
,
Acta medica Lituanica: Vol. 27 No. 2 (2020): Acta medica Lituanica
-
Vilija Malinauskienė,
Lina Bernotaitė,
The Impact of Event Scale – Revised: psychometric properties of the Lithuanian version in a sample of employees exposed to workplace bullying
,
Acta medica Lituanica: Vol. 23 No. 3 (2016)
-
Luize Auzina,
Elina Skuja,
Toms Janis Safranovs,
Valts Ozolins,
Helmuts Kidikas,
Gita Taurina,
Inguna Lubaua,
A giant arteriovenous malformation and fistula in a newborn with Parkes Weber syndrome. Case report
,
Acta medica Lituanica: Vol. 27 No. 2 (2020): Acta medica Lituanica
-
Laura Steponavičienė,
Rūta Briedienė,
Rasa Vansevičiūtė-Petkevičienė,
Daiva Gudavičienė,
Ieva Vincerževskienė,
Breast cancer screening program in Lithuania: trends in breast cancer mortality before and during the introduction of the mammography screening programme
,
Acta medica Lituanica: Vol. 27 No. 2 (2020): Acta medica Lituanica
-
Jūratė Gudaitytė,
Dominykas Dvylys,
Indrė Šimeliūnaitė,
Anaesthetic challenges in cancer patients: current therapies and pain management
,
Acta medica Lituanica: Vol. 24 No. 2 (2017)
-
Daniel Paramythiotis,
Eleni Karlafti,
Georgia Fotiadou,
Maria Charalampidou,
Anestis Karakatsanis,
Aristeidis Ioannidis,
Antonios Michalopoulos,
Pancreatic Intraductal Papillary Mucinous Neoplasms: A Narrative Review
,
Acta medica Lituanica: Vol. 30 No. 1 (2023): Acta medica Lituanica
-
Ugur Gonlugur,
Tanseli Gonlugur,
Sule Ozer,
Middle Lobe Syndrome Associated with Bronchial Anthracofibrosis
,
Acta medica Lituanica: Vol. 27 No. 2 (2020): Acta medica Lituanica
-
Austėja Voiniušytė,
Miglė Černiauskaitė,
Virginija Paliulytė,
Rūta Einikytė,
Diana Ramašauskaitė,
Vaccination Against COVID-19 Disease During Pregnancy
,
Acta medica Lituanica: Vol. 29 No. 1 (2022): Acta medica Lituanica
-
Olga Rimdenoka,
Māra Pilmane,
Evaluation of TGF-β1 and EGFR in Cleft Affected Lip Mucosa
,
Acta medica Lituanica: Vol. 28 No. 1 (2021): Acta medica Lituanica
-
Živilė Gudlevičienė,
Raminta Baušytė,
Evelina Dagytė,
Danutė Balkelienė,
Algirdas Utkus,
Diana Ramašauskaitė,
The First Live Birth in Lithuania After Application of Preimplantation Genetic Testing
,
Acta medica Lituanica: Vol. 27 No. 2 (2020): Acta medica Lituanica