Evolving concepts in the management of the preschool wheezer

Abstract

Dividing preschool wheezing infants into episodic wheezers or multitrigger wheezers, or into groups used in longitudinal cohorts may only be clinically useful if temporal factors such as severity and frequency, and clinical parameters such as age of onset, pattern and severity, atopy and eczema are taken into account. There is little evidence to suggest that phenotypes described are related to pathobiological processes. The challenge is to identify phenotypes associated with a pathobiological process and longitudinal outcome and response to a specific therapy. In clinical practice therapy should be decided by identifying the preschool infant as an episodic viral wheezer or a multitrigger wheezer and by determining the association with the child’s asthma predictive index (API), age of onset of wheeze and degree of atopic sensitisation. The wheezy preschool child with a positive API and evidence of multiple atopic sensitisation is more likely to respond to therapy.