Title
Preschool Wheezing Disorders
Authoring Organization
Publication Month/Year
June 6, 2024
Last Updated Month/Year
July 12, 2024
Supplemental Implementation Tools
Document Type
Consensus
Country of Publication
European
Document Objectives
Since the publication of the European Respiratory Society (ERS) Task Force reports on the management of preschool wheezing in 2008 and 2014, a large body of evidence has accumulated suggesting the clinical phenotypes that were proposed, episodic (viral) wheezing and multiple-trigger wheezing, do not relate to underlying airway pathology and may not help determine response to treatment. Specifically, using clinical phenotypes alone may no longer be appropriate, and new approaches that can be used to inform clinical care are needed for future research. This ERS Task Force reviewed the literature published after 2008 related to preschool wheezing and has suggested the criteria used to define wheezing disorders in preschool children should include age of diagnosis (0 to <6 years), confirmation of wheezing on at least one occasion, and more than one episode of wheezing ever.Furthermore, diagnosis and management may be improved by identifying treatable traits, including inflammatory biomarkers (blood eosinophils, aeroallergen sensitisation) associated with type-2 immunity and differential response to inhaled corticosteroids, lung function parameters, and airway infection. However, more comprehensive use of biomarkers/treatable traits in predicting the response to treatment requires prospective validation. There is evidence that specific genetic traits may help guide management, but these must be adequately tested. In addition, the Task Force identified an absence of caregiver-reported outcomes, caregiver/self-management options, and features that should prompt specialist referral for this age group. Priorities for future research include a focus on identifying i) mechanisms driving preschool wheezing, ii) biomarkers of treatable traits and efficacy of interventions in those without allergic sensitisation/eosinophilia, iii) the need to include both objective outcomes and caregiver-reported outcomes in clinical trials, iv) the need for a suitable action plan for children with preschool wheezing and v) a definition of severe/difficult-to-treat preschool wheezing.
Inclusion Criteria
Male, Female, Child
Health Care Settings
Ambulatory, Childcare center, School
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management
Keywords
wheezing
Source Citation
Makrinioti H, Fainardi V, Bonnelykke K, Custovic A, Cicutto L, Coleman C, Eiwegger T, Kuehni C, Moeller A, Pedersen E, Pijnenburg M, Pinnock H, Ranganathan S, Tonia T, Subbarao P, Saglani S. European Respiratory Society Statement on preschool wheezing disorders: updated definitions, knowledge gaps, and proposed future research directions. Eur Respir J. 2024 Jun 6:2400624. doi: 10.1183/13993003.00624-2024. Epub ahead of print. PMID: 38843917.