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)
-
Arnoldas Krasauskas,
Renatas Aškinis,
Sigitas Zaremba,
Giedrė Smailytė,
Saulius Cicėnas,
Surgery for lung cancer as the second primary malignancy
,
Acta medica Lituanica: Vol. 19 No. 4 (2012)
-
Tautvydas Rančelis,
Loreta Cimbalistienė,
Vaidutis Kučinskas,
Next-generation whole-exome sequencing contribution to identification of rare autosomal recessive diseases
,
Acta medica Lituanica: Vol. 20 No. 1 (2013)
-
Ilona Savlan,
Valentina Liakina,
Jonas Valantinas,
Diagnosis and treatment of hepatic encephalopathy
,
Acta medica Lituanica: Vol. 20 No. 1 (2013)
-
Yemisi Olukemi ADESIJI,
Benjamin Obukowho EMIKPE,
Ahmed Bayo OPALEKUNDE,
Histopathological and functional changes in the testicles of albino rats experimentally infected with Arcobacter butzleri
,
Acta medica Lituanica: Vol. 18 No. 3 (2011)
-
Robertas ADOMAITIS,
Feliksas JANKEVICIUS,
Giedre SMAILYTE,
Ruta LEVULIENE,
Changes in prostate cancer incidence in 50–75-year-old men in Lithuania 2006–2009: effect of early diagnosis program
,
Acta medica Lituanica: Vol. 18 No. 2 (2011)
-
Ilona Šuškevičienė,
Tomas Bukauskas,
Aurika Karbonskienė,
Andrius Macas,
Challenges in the management of acquired tracheal stenosis: a case report
,
Acta medica Lituanica: Vol. 19 No. 3 (2012)
-
Rasa Liutkevičienė,
Rasa Čiumbaraitė,
Mantas Banevičius,
A comparison of contrast sensitivity in early mild and early intermediate age-related macular degeneration after adjusting for age and visual acuity
,
Acta medica Lituanica: Vol. 22 No. 4 (2015)
-
Vytė Valerija Maneikienė,
Donatas Vajauskas,
Audrius Aidietis,
Algirdas Edvardas Tamošiūnas,
Kęstutis Ručinskas,
Eglė Skiauterytė,
Germanas Marinskis,
Prognostic value of cardiac iodine-123 metaiodobenzylguanidine imaging in patients with indications for cardiac resynchronization therapy
,
Acta medica Lituanica: Vol. 21 No. 2 (2014)
-
Juras Kišonas,
Arvydas Burneckis,
Andrius Ivanauskas,
Romualdas Mickevičius,
Alvydas Vėželis,
First experience of salvage HDR brachytherapy after prostate cancer radiotherapy
,
Acta medica Lituanica: Vol. 21 No. 4 (2014)
-
Giedrė Bulotienė,
Gabrielė Jagelavičiūtė,
Assessment of the efficacy of communication skills training program for oncologists
,
Acta medica Lituanica: Vol. 22 No. 4 (2015)