Wheeze in preschool children is common. In a small proportion of children, it can be very troublesome, requiring repeated visits for medical attention. Response to treatment is variable and often disappointing. Children with frequent wheeze, particularly if they have a family history of asthma, are likely to benefit from inhaled corticosteroids, in terms of both improved symptom control and reduced number and severity of exacerbations. Children with infrequent episodic wheeze do not benefit from regular inhaled corticosteroids, and their use should be avoided in children with this pattern of wheeze.
Get full access to this article
View all access options for this article.
References
1.
MartinezFD, WrightAL, TaussigLM, HolbergCJ, HalonenM, MorganWJ. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med, 1995; 332:133–138.
2.
SternDA, MorganWJ, HalonenM, WrightAL, MartinezFD. Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study. Lancet, 2008; 372:1058–1064.
3.
Castro-RodríguezJA, HolbergCJ, WrightAL, MartinezFD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med, 2000; 162:1403–1406.
4.
CaudriD, WijgaA, A SchipperCM, HoekstraM, PostmaDS, KoppelmanGH, BrunekreefB, SmitHA, de JongsteJC. Predicting the long-term prognosis of children with symptoms suggestive of asthma at preschool age. J Allergy Clin Immunol, 2009; 124:903–910.
5.
CaneRS, RanganathanSC, McKenzieSA. What do parents of wheezy children understand by “wheeze”?Arch Dis Child, 2000; 82:327–332.
6.
BrandPL, BaraldiE, BisgaardH, BonerAL, Castro-RodriguezJA, CustovicA, de BlicJ, de JongsteJC, EberE, EverardML, FreyU, GappaM, Garcia-MarcosL, GriggJ, LenneyW, Le SouëfP, McKenzieS, MerkusPJ, MidullaF, PatonJY, PiacentiniG, PohunekP, RossiGA, SeddonP, SilvermanM, SlyPD, StickS, ValiulisA, van AalderenWM, WildhaberJH, WennergrenG, WilsonN, ZivkovicZ, BushA. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J, 2008; 32:1096–1110.
7.
SchultzA, DevadasonSG, SavenijeOE, SlyPD, Le SouëfPN, BrandPL. The transient value of classifying preschool wheeze into episodic viral wheeze and multiple trigger wheeze. Acta Paediatr, 2010; 99:56–60.
8.
MorganWJ, SternDA, SherrillDL, GuerraS, HolbergCJ, GuilbertTW, TaussigLM, WrightAL, MartinezFD. Outcome of asthma and wheezing in the first 6 years of life: follow-up through adolescence. Am J Respir Crit Care Med, 2005; 172:1253–1258.
9.
GuilbertTW, MorganWJ, ZeigerRS, MaugerDT, BoehmerSJ, SzeflerSJ, BacharierLB, LemanskeRFJr., StrunkRC, AllenDB, BloombergGR, HeldtG, KrawiecM, LarsenG, LiuAH, ChinchilliVM, SorknessCA, TaussigLM, MartinezFD. Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med, 2006; 354:1985–1997.
10.
MurrayCS, WoodcockA, LangleySJ, MorrisJ, CustovicA. IFWIN study team. Secondary prevention of asthma by the use of Inhaled Fluticasone propionate in Wheezy INfants (IFWIN): double-blind, randomised, controlled study. Lancet, 2006; 368:754–762.
11.
BisgaardH, HermansenMN, LolandL, HalkjaerLB, BuchvaldF. Intermittent inhaled corticosteroids in infants with episodic wheezing. N Engl J Med, 2006; 354:1998–2005.
12.
Castro-RodriguezJA, RodrigoGJ. Efficacy of inhaled corticosteroids in infants and preschoolers with recurrent wheezing and asthma: a systematic review with meta-analysis. Pediatrics, 2009; 123:519–525.
13.
RoordaRJ, MezeiG, BisgaardH, MadenC. Response of preschool children with asthma symptoms to fluticasone propionate. J Allergy Clin Immunol, 2001; 108:540–546.
14.
BacharierLB, GuilbertTW, ZeigerRS, StrunkRC, MorganWJ, LemanskeRFJr., MossM, SzeflerSJ, KrawiecM, BoehmerS, MaugerD, TaussigLM, MartinezFD. Childhood Asthma Research Education Network of the National Heart Lung, Blood Institute. Patient characteristics associated with improved outcomes with use of an inhaled corticosteroid in preschool children at risk for asthma. J Allergy Clin Immunol, 2009; 123:1077–1082.
15.
WilsonN, SloperK, SilvermanM. Effect of continuous treatment with topical corticosteroid on episodic viral wheeze in preschool children. Arch Dis Child, 1995; 2:17–20.
16.
DoullIJ, LampeFC, SmithS, SchreiberJ, FreezerNJ, HolgateST. Effect of inhaled corticosteroids on episodes of wheezing associated with viral infection in school age children: randomised double blind placebo controlled trial. BMJ, 1997; 315:858–862.
17.
WilsonNM, SilvermanM. Treatment of acute, episodic asthma in preschool children using intermittent high dose inhaled steroids at home. Arch Dis Child, 1990; 65:407–410.
18.
ConnettG, LenneyW. Prevention of viral induced asthma attacks using inhaled budesonide. Arch Dis Child, 1993; 68:85–87.
19.
SvedmyrJ, NybergE, ThunqvistP, Asbrink-NilssonE, HedlinG. Prophylactic intermittent treatment with inhaled corticosteroids of asthma exacerbations due to airway infections in toddlers. Acta Paediatr, 1999; 88:42–47.
20.
BacharierLB, PhillipsBR, ZeigerRS, SzeflerSJ, MartinezFD, LemanskeRFJr., SorknessCA, BloombergGR, MorganWJ, PaulIM, GuilbertT, KrawiecM, CovarR, LarsenG, MellonM, MossMH, ChinchilliVM, TaussigLM, StrunkRC. CARE Network. Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with moderate-to-severe intermittent wheezing. J Allergy Clin Immunol, 2008; 122:1127–1135.
21.
DucharmeFM, LemireC, NoyaFJ, DavisGM, AlosN, LeblondH, SavdieC, ColletJP, KhomenkoL, RivardG, PlattRW. Preemptive use of high-dose fluticasone for virus-induced wheezing in young children. N Engl J Med, 2009; 360:339–353.
22.
RobertsonCF, PriceD, HenryR, MellisC, GlasgowN, FitzgeraldD, LeeAJ, TurnerJ, SantM. Short-course montelukast for intermittent asthma in children: a randomized controlled trial. Am J Respir Crit Care Med, 2007; 175:323–329.
23.
GrantCC, DugganAK, DeAngelisC. Independent parental administration of prednisone in acute asthma: a double-blind, placebo-controlled, crossover study. Pediatrics, 1995; 96:224–229.
24.
OommenA, LambertPC, GriggJ. Efficacy of a short course of parent-initiated oral prednisolone for viral wheeze in children aged 1–5 years: randomised controlled trial. Lancet, 2003; 362:1433–1438.
25.
PanickarJ, LakhanpaulM, LambertPC, KeniaP, StephensonT, SmythA, GriggJ. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med, 2009; 360:329–338.
