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)
-
Rasa Čiumbaraitė,
Rasa Liutkevičienė,
Refractive errors characteristic of the patients at the Children’s Ophthalmology Outpatient Department of Kauno klinikos Hospital (Lithuanian University of Health Sciences) from 1 January 2012 to 31 December 2012
,
Acta medica Lituanica: Vol. 24 No. 2 (2017)
-
Nikas Samuolis,
Narimantas Evaldas Samalavičius,
Ugnius Mickys,
Elective colectomy after colonoscopic polypectomy for unexpected polypoid T1 cancer
,
Acta medica Lituanica: Vol. 22 No. 1 (2015)
-
Folke Sjöberg,
Fluid therapy in burns
,
Acta medica Lituanica: Vol. 19 No. 3 (2012)
-
Edita Naruševičiūtė-Skripkienė,
Beatričė Moskalionė,
Aistė Audickaitė,
Jūratė Grigaitienė,
Matilda Bylaitė-Bučinskienė,
Garment industry in Lithuania: a study of self-reported dermatological problems
,
Acta medica Lituanica: Vol. 22 No. 3 (2015)
-
Iveta PAULAUSKIENĖ,
Eugenijus LESINSKAS,
Laryngopharyngeal complaints following short-term endotracheal intubation: peculiarities of males and females
,
Acta medica Lituanica: Vol. 19 No. 2 (2012)
-
Laima LEONAVIČIENĖ,
Danutė POVILĖNAITĖ,
Rūta BRADŪNAITĖ,
Dalia VAITKIENĖ,
Algirdas VENALIS,
Treatment of experimental amyloidosis with antirheumatic drugs
,
Acta medica Lituanica: Vol. 17 No. 1-2 (2010)
-
Sigitas Laima,
Dmitrij Fomin,
Algimantas Jasulaitis,
Gerda Andriuškevičiūtė,
Sigitas Chmieliauskas,
Vaidas Sabaliauskas,
Vladimiras Sergejevas,
The effect of conducted electrical weapons on the human body
,
Acta medica Lituanica: Vol. 21 No. 2 (2014)
-
Rasa Liutkevičienė,
Ramunė Sungailienė,
Alvita Vilkevičiūtė,
Loresa Kriaučiūnienė,
Paulina Vaitkienė,
Romanas Chaleckis,
Vytenis Pranas Deltuva,
Associations between CYP2C8 rs10509681 and rs11572080 gene polymorphisms and age-related macular degeneration
,
Acta medica Lituanica: Vol. 24 No. 2 (2017)
-
Živilė Deimantavičienė,
Nerijus Klimas,
Aurimas Pečkauskas,
Giedrė Bakšytė,
Andrius Macas,
Linas Pieteris,
Aurelija Repšienė,
Complications of thrombolysis in an intensive care unit
,
Acta medica Lituanica: Vol. 19 No. 3 (2012)
-
Vida GARALIENĖ,
Linas LABANAUSKAS,
Algirdas BRŪKŠTUS,
Vygantas BARSYS,
Effect of 1-acyl-5,6-dimethoxy / diethoxy-2-methylthiobenzimidazoles on APD90 and isometric contraction in guinea pig atrium and aortic preparations activated by carbachol and phenylephrine
,
Acta medica Lituanica: Vol. 17 No. 3-4 (2010)