Approaching a preschool child with recurrent asthma – when to set the diagnosis of asthma and how to treat the patient?

Abstract

Asthma is one of the most common respiratory symptoms in preschool children. In most cases, asthma is exclusively associated withviral infections of the upper airways and resolves with time; however, one-third of children with recurrent asthma are diagnosed withasthma when they reach school age. According to professional society guidelines, recurrent asthma in preschool children is generallyclassifi ed into phenotypes, depending on the frequency of symptoms and their association with particular triggers. Infl ammatorypathogenesis of asthma phenotypes in preschool children has not yet been established; however, various infl ammatory mechanismsare likely to be involved. The majority of preschool children with recurrent asthma can only be treated with bronchodilators.According to the European Respiratory Society guidelines, anti-infl ammatory therapy should be introduced in patients with frequentsymptoms and severe clinical picture. Measuring objective parameters such as pulmonary function and airway hyperreactivity isquite diffi cult due to patient noncompliance, thus therapy initiation and good clinical response probably provide the most reliablebasis for diagnosing asthma. For now, there are no treatment strategies to modify the course of the disease and prevent developmentof persistent asthma.