Preschool Wheezing Phenotypes

*Andrew Bush,1-3 Prasad Nagakumar2,3

1. Department of Paediatrics, Imperial College London, London, UK
2. Department of Paediatric Respirology, National Heart and Lung Institute, Imperial College London, London, UK
3. Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
*Correspondence to a.bush@imperial.ac.uk

Disclosure: A. Bush was supported by the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London. P. Nagakumar has declared no conflicts of interest.
Received: 16.02.15 Accepted: 30.07.15
Citation: EMJ 2016;1[1]:93-101.

Abstract

Wheezing in preschool children is very common, with a wide differential diagnosis. It is essential to be sure of the exact sound that parents are describing; the term ‘wheeze‘ is often applied to non-specific sounds. Structural airway disease such as vascular ring should be considered. Thereafter we propose that umbrella terms for preschool wheeze should be abandoned in favour of ‘Hargreave phenotyping’, in which the presence and extent of the components of infection, inflammation, variable airflow obstruction, and fixed airflow obstruction are determined as far as is possible, rather than using a general umbrella term such as ‘asthma’. The justification for this approach is that it leads to a logical approach to treatment in the disparate airway diseases presenting in the preschool years, and should hopefully prevent over-treatment with inhaled corticosteroids. If, despite this approach, doubt remains as to the nature of the airway disease, then a therapeutic trial of treatment is permissible, but it should be for a short defined period only. In any event, such children should be reviewed regularly to see if treatments need to be changed.

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