Definition, assessment and treatment of wheezing disorders in preschool children: An evidence-based approach

P. L P Brand, E. Baraldi, H. Bisgaard, A. L. Boner, J. A. Castro-Rodriguez, A. Custovic, J. De Blic, J. C. De Jongste, E. Eber, M. L. Everard, U. Frey, M. Gappa, L. Garcia-Marcos, J. Grigg, W. Lenney, P. Le Souëf, S. McKenzie, P. J F M Merkus, F. Midulla, J. Y. PatonG. Piacentini, P. Pohunek, G. A. Rossi, P. Seddon, M. Silverman, P. D. Sly, S. Stick, A. Valiulis, W. M C Van Aalderen, J. H. Wildhaber, G. Wennergren, N. Wilson, Z. Zivkovic, A. Bush

Research output: Contribution to journalArticle

Abstract

There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting β2-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes. Copyright

Original languageEnglish
Pages (from-to)1096-1110
Number of pages15
JournalEuropean Respiratory Journal
Volume32
Issue number4
DOIs
Publication statusPublished - Oct 2008

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montelukast
Respiratory Sounds
Preschool Children
Phenotype
Adrenal Cortex Hormones
Metered Dose Inhalers
Advisory Committees
Therapeutics
Smoke
Allergens
Tobacco
Randomized Controlled Trials
Parents

Keywords

  • Asthma
  • Episodic viral wheeze
  • Inhaled corticosteroids
  • Montelukast
  • Multiple-trigger wheeze

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Brand, P. L. P., Baraldi, E., Bisgaard, H., Boner, A. L., Castro-Rodriguez, J. A., Custovic, A., ... Bush, A. (2008). Definition, assessment and treatment of wheezing disorders in preschool children: An evidence-based approach. European Respiratory Journal, 32(4), 1096-1110. https://doi.org/10.1183/09031936.00002108

Definition, assessment and treatment of wheezing disorders in preschool children : An evidence-based approach. / Brand, P. L P; Baraldi, E.; Bisgaard, H.; Boner, A. L.; Castro-Rodriguez, J. A.; Custovic, A.; De Blic, J.; De Jongste, J. C.; Eber, E.; Everard, M. L.; Frey, U.; Gappa, M.; Garcia-Marcos, L.; Grigg, J.; Lenney, W.; Le Souëf, P.; McKenzie, S.; Merkus, P. J F M; Midulla, F.; Paton, J. Y.; Piacentini, G.; Pohunek, P.; Rossi, G. A.; Seddon, P.; Silverman, M.; Sly, P. D.; Stick, S.; Valiulis, A.; Van Aalderen, W. M C; Wildhaber, J. H.; Wennergren, G.; Wilson, N.; Zivkovic, Z.; Bush, A.

In: European Respiratory Journal, Vol. 32, No. 4, 10.2008, p. 1096-1110.

Research output: Contribution to journalArticle

Brand, PLP, Baraldi, E, Bisgaard, H, Boner, AL, Castro-Rodriguez, JA, Custovic, A, De Blic, J, De Jongste, JC, Eber, E, Everard, ML, Frey, U, Gappa, M, Garcia-Marcos, L, Grigg, J, Lenney, W, Le Souëf, P, McKenzie, S, Merkus, PJFM, Midulla, F, Paton, JY, Piacentini, G, Pohunek, P, Rossi, GA, Seddon, P, Silverman, M, Sly, PD, Stick, S, Valiulis, A, Van Aalderen, WMC, Wildhaber, JH, Wennergren, G, Wilson, N, Zivkovic, Z & Bush, A 2008, 'Definition, assessment and treatment of wheezing disorders in preschool children: An evidence-based approach', European Respiratory Journal, vol. 32, no. 4, pp. 1096-1110. https://doi.org/10.1183/09031936.00002108
Brand, P. L P ; Baraldi, E. ; Bisgaard, H. ; Boner, A. L. ; Castro-Rodriguez, J. A. ; Custovic, A. ; De Blic, J. ; De Jongste, J. C. ; Eber, E. ; Everard, M. L. ; Frey, U. ; Gappa, M. ; Garcia-Marcos, L. ; Grigg, J. ; Lenney, W. ; Le Souëf, P. ; McKenzie, S. ; Merkus, P. J F M ; Midulla, F. ; Paton, J. Y. ; Piacentini, G. ; Pohunek, P. ; Rossi, G. A. ; Seddon, P. ; Silverman, M. ; Sly, P. D. ; Stick, S. ; Valiulis, A. ; Van Aalderen, W. M C ; Wildhaber, J. H. ; Wennergren, G. ; Wilson, N. ; Zivkovic, Z. ; Bush, A. / Definition, assessment and treatment of wheezing disorders in preschool children : An evidence-based approach. In: European Respiratory Journal. 2008 ; Vol. 32, No. 4. pp. 1096-1110.
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AU - Castro-Rodriguez, J. A.

AU - Custovic, A.

AU - De Blic, J.

AU - De Jongste, J. C.

AU - Eber, E.

AU - Everard, M. L.

AU - Frey, U.

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AU - Garcia-Marcos, L.

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AU - Midulla, F.

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AU - Piacentini, G.

AU - Pohunek, P.

AU - Rossi, G. A.

AU - Seddon, P.

AU - Silverman, M.

AU - Sly, P. D.

AU - Stick, S.

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AU - Wildhaber, J. H.

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AU - Bush, A.

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