Is Every Wheeze Asthma?
DOI:
https://doi.org/10.13112/pc.991Keywords:
Wheezing, Preschool child, phenotype, Asthma, BiomarkersAbstract
Childhood wheezing is a common cause of outpatient visits and hospital admissions in children under 5 years of age. A new approach to the treatment of recurrent wheezing emphasizes the importance of biomarkers. Preschool children with recurrent wheezing and peripheral eosinophilia and/or allergic sensitization to inhaled allergens are good candidates for treatment with inhaled corticosteroids (ICS). Children with predominant neutrophilia often require antibiotic therapy and are refractory to ICS therapy. The diagnosis of asthma in this age group is clinical and is made on the basis of symptoms between exacerbations, markers of atopy, personal and family history of allergic disease and response to ICS therapy.
References
1. Bloom CI, Franklin C, Bush A, et al. Burden of preschool wheeze and progression to asthma in the UK: population-based cohort 2007 to 2017. J Allergy Clin Immunol. 2021;147:1949–58. 10.1016/j.jaci.2020.12.643
2. Topalušić I, Stipić Marković A, Artuković M, et al. Divergent Trends in the Prevalence of Children's Asthma, Rhinitis and Atopic Dermatitis and Environmental Influences in the Urban Setting of Zagreb, Croatia. Children (Basel, Switzerland). 2022;9:1788. https://doi.org/10.3390/children9121788
3. Stein R T, Martinez F D. Asthma phenotypes in childhood: lessons from an epidemiological approach. Paediatric respiratory reviews. 2024;5:155–161. https://doi.org/10.1016/j.prrv.2004.01.007
4. Bush A. Basic clinical management of preschool wheeze. Pediatr Allergy Immunol. 2023;34: e13988 https://doi.org/10.1111/pai.13988
5. Brand PL, Baraldi E, Bisgaard H, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J. 2008 ;32:1096-110. doi: 10.1183/09031936.00002108.
6. Brand PL, Caudri D, Eber E, et al. Classification and pharmacological treatment of preschool wheezing: changes since 2008. Eur Respir J. 2014;43:1172-7. doi: 10.1183/09031936.00199913. Epub 2014 Feb 13.
7. Fuchs O, Bahmer T, Rabe KF, et al. Asthma transition from childhood into aduldhood. Lancet Respir Med. 2017;5:224-34.
8. Makrinioti H, Fainardi V, Bonnelykke E, et al. European Respiratory Society statement on preschool wheezing disorders: updated definitions, knowledge gaps and proposed future research directions. Eur Respir J. 2024;5;64:2400624
9. https://ginasthma.org/2024-report/. Pristupljeno 6.11. 2024.
10. Marchant JM, Masters IB, Taylor SM, et al. Evaluation and outcome of young children with chronic cough. Chest. 2006; 129: 1132-1141.
11. Sintusek P, Mutalib M, Thapar N. Gastroesophageal reflux disease in children: What's new right now? World J Gastrointest Endosc. 2023;15:84-102. doi: 10.4253/wjge.v15.i3.84.
12. Pavić I, Šarkanji-Golub R, Hojsak I. Diagnostic Utility of pH-MII Monitoring in Preschool Children with Recurrent Wheeze and Suspected Gastroesophageal Reflux Disease: A Prospective Study. Diagnostics (Basel). 2023;13:3567. doi: 10.3390/diagnostics13233567
13. Chang AB, Bush A, Grimwood K. Bronchiectasis in children. Lancet. 2018; 392: 866-879.
14. Chang AB, Fortescue R, Grimwood K, et al. Task force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J. 2021; 58:2002990.
15. Fitzpatrick AM, Jackson DJ, Mauger DT, et al. Individualized therapy for persistent asthma in young children. J Allergy Clin Immunol. 2016;138:1608–1618. doi 10.1016/j.jaci.2016.09.028
16. Holguin F, Cardet JC, Chung KF, et al. Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2020; 55:1900588.
17. Guiddir T, Saint-Pierre P, Purenne-Denis E, et al. Neutrophilic Steroid-Refractory Recurrent Wheeze and Eosinophilic Steroid-Refractory Asthma in Children. J Allergy Clin Immunol Pract.. 2017;5:1351-1361.e2. doi: 10.1016/j.jaip.2017.02.003. Epub 2017 Mar 28.
18. Schwerk N, Brinkmann F, Soudah B, et al. Wheeze in preschool age is associated with pulmonary bacterial infection and resolves after antibiotic therapy. PLoS One. 2011;6:e27913.
19. Robinson PFM, Fontanella S, Ananth S, et al. Recurrent severe preschool wheeze: from prespecified diagnostic labels to underlying endotypes. Am J Respir Crit Care Med. 2021;204:523‐535
20. Scotney E, Fleming L, Saglani S, et al. Advances in the pathogenesis and personalised treatment of paediatric asthma. BMJ medicine. 2022;2:e000367. https://doi.org/10.1136/bmjmed-2022-000367
21. Durchane FM, Lemire C, Noya FJ, et al. Preemptive use of high-dose fluticasone for virus-induced wheezing in young children. N Engl J Med. 2009; 360: 339–353.
22. Robertson CF, Price D, Henry R, et al. Short-course montelukast for intermittent asthma in children: a randomized controlled trial. Am J Respir Crit Care Med. 2007; 175: 323-329.
23. Bacharier LB, Phillips BR, Zeiger RS, et al. Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with moderate-to-severe intermittent wheezing. J Allergy Clin Immuno.l. 2008; 122: 1127-1135.
24. Valovirta E, Boza ML, Robertson CF, et al. Intermittent or daily montelukast versus placebo for episodic asthma in children. Ann Allergy Asthm Immunol. 2011; 106: 518-526.
25. Nwokoro C, Pandya H, Turner S, et al. Intermittent montelukast in children aged 10 months to 5 years with wheeze (WAIT trial): a multicentre, randomised, placebo-controlled trial. Lancet Respir Med. 2014; 2: 796-803.
26. Stokholm J, Chawes BL, Vissing NH, et al. Azithromycin for episodes with asthma-like symptoms in young children aged 1-3 years: a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2016;4: 19-26
27. Mandhane PJ, Paredes Zambrano de Silbernagel P, et al. Treatment of preschool children presenting to the emergency department with wheeze with azithromycin: A placebo-controlled randomized trial. PLoS One. 2017: 12: e0182411
28. Rossi G, Esposito S, Feleszko W, et al. Immunomodulation Therapy – Clinical Relevance of Bacterial Lysates OM-85. European Respiratory & Pulmonary Diseases 2019;15:17–23.DOI: https://doi.org/10.17925/ERPD.2019.5.1.17
29. Esposito S, Marchisio P, Prada E . Impact of a mixed bacterial lysate (OM-85 BV) on the immunogenicity, safety and tolerability of inactivated influenza vaccine in children with recurrent respiratory tract infection. Vaccine. 2014;32:2546–52. 32.
30. Lu Y, Li Y, Xu L. Bacterial lysate increases the percentage of natural killer T cells in peripheral blood and alleviates asthma in children. Pharmacology. 2015;95:139–144.
31. Razi CH, Harmanci K, Abaci A, et al. The immunostimulant OM-85 BV prevents wheezing attacks in preschool children. J Allergy Clin Immunol. 2010;126:763–769.
32. Sly PD, Galbraith S, Islam Z, et al. Primary prevention of severe lower respiratory illnesses in at-risk infants using the immunomodulator OM-85. J Allergy Clin Immunol. 2019;144:870-872.e11. doi: 10.1016/j.jaci.2019.05.032
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Iva Topalušić
This work is licensed under a Creative Commons Attribution 4.0 International License.
By publishing in Paediatria Croatica, authors retain the copyright to their work and grant others the right to use, reproduce, and share their research articles in accordance with the Creative Commons Attribution License (CC BY 4.0), which allows others to distribute and build upon the work as long as they credit the author for the original creation.
