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Management of Recurrent Preschool, Doctor-Diagnosed Wheeze

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Abstract

Preschool wheeze occurs in half of the children before they reach 6 y of age and recurrence is also common. Recurrent preschool wheeze is classified as either typical or atypical. For typical recurrent preschool wheeze, the diagnoses are either asthma or bronchiolitis/bronchitis. Responsiveness to a properly administered bronchodilator confirms asthma, atopic or otherwise. All atypical preschool wheeze should be referred to pediatric respirologist for assessment. Lung function test by impulse oscillometry (IOS) before and after bronchodilator is helpful to confirm airway hyperresponsiveness, an essential feature of asthma. Assessment of atopy is important by either skin prick test or serum IgE level. Treatment of acute wheeze includes standard supportive care, bronchodilator for those diagnosed with asthma and hypertonic saline for those diagnosed as having acute bronchiolitis. Other treatments included nebulized adrenaline for acute bronchiolitis and systemic steroids for asthma. For those with significant respiratory distress, continuous positive airway pressure (CPAP) or heated humidified high flow should be considered. Daily or intermittent inhaled corticosteroid or intermittent montelukast would reduce asthma exacerbation rate. A significant proportion of preschool wheeze persists till school age. An early diagnosis of asthma would be important to allow early optimal management.

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References

  1. Bush A, Grigg J, Saglani S. Managing wheeze in preschool children. BMJ. 2014;348:g15.

    Article  PubMed  CAS  Google Scholar 

  2. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med. 1995;332:133–8.

    Article  PubMed  CAS  Google Scholar 

  3. Bisgaard H, Szefler S. Prevalence of asthma-like symptoms in young children. Pediatr Pulmonol. 2007;42:723–8.

    Article  PubMed  Google Scholar 

  4. Ducharme FM, Tse SM, Chauhan B. Diagnosis, management, and prognosis of preschool wheeze. Lancet. 2014;383:1593–604.

    Article  PubMed  Google Scholar 

  5. Peroni DG, Piacentini GL, Bodini A, Boner AL. Preschool asthma in Italy: prevalence, risk factors and health resource utilization. Respir Med. 2009;103:104–8.

    Article  PubMed  Google Scholar 

  6. Chiu W, Lee LP, Ng DK, Lau TK, Lam P, Chan JY. Consensus report on management of wheezing in preschool children, Hong Kong Society of Paediatric Respirology. JPRCC. 2011;7:4–13.

    Google Scholar 

  7. British Thoracic Society, Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. BTS/SIGN, 2016. Available at: http://www.sign.ac.uk/sign-153-british-guideline-on-the-management-of-asthma.html. Accessed 07 June 2017.

  8. Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134:e1474–502.

    Article  PubMed  Google Scholar 

  9. National Institute for Health and Care Excellence. Bronchiolitis: diagnosis and managementof bronchiolitis in children. (Clinical guideline ng9.) 2015. Available at: www.nice.org.uk/guidance/ng9. Accessed 07 June 2017.

  10. The Royal Children’s Hospital Melbourne, Clinical Practice Guidelines. Bronchiolitis. Available at: http://www.rch.org.au/clinicalguide/guideline_index/Bronchiolitis_Guideline/. Accessed 07 June 2017.

  11. Cane RS, Ranganathan SC, McKenzie SA. What do parents of wheezy children understand by "wheeze"? Arch Dis Child. 2000;82:327–32.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Cane RS, McKenzie SA. Parents' interpretations of children's respiratory symptoms on video. Arch Dis Child. 2001;84:31–4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Levy ML, Godfrey S, Irving CS, et al. Wheeze detection: recordings vs. assessment of physician and parent. J Asthma. 2004;41:845–53.

    Article  PubMed  CAS  Google Scholar 

  14. Lowe L, Murray CS, Martin L, et al. Reported versus confirmed wheeze and lung function inearly life. Arch Dis Child. 2004;89:540–3.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Mallol J, García-Marcos L, Solé D, Brand P; EISL Study Group. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65:1004–9.

  16. Saglani S, Malmström K, Pelkonen AS, et al. Airway remodeling and inflammation in symptomatic infants with reversible airflow obstruction. Am J Respir Crit Care Med. 2005;171:722–7.

    Article  PubMed  Google Scholar 

  17. Bush A, Nagakumar P. Preschool wheezing phenotypes. EMJ. 2016;1:93–101.

    Google Scholar 

  18. Yu PT, Chan JY, Poon F, et al. The predictive factors in preschool wheezers for subsequent asthma hospitalization after the age of 6 years. Pediatr Respirol Crit Care Med. 2017;1:11–6.

  19. 2017 Pocket Guide for Asthma Management and Prevention. Global Initiative for Asthma (GINA). Available at: http://ginasthma.org/19.-pocket-guide-for-asthma-management-and-pre vention/. Accessed 07 June 2017.

  20. Ducharme FM, Dell SD, Radhakrishnan D, et al. Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper. Can Respir J. 2015;22:135–43.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 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.

    Article  PubMed  CAS  Google Scholar 

  22. Saglani S, Payne DN, Zhu J, et al. Early detection of airway wall remodeling and eosinophilic inflammation in preschool wheezers. Am J Respir Crit Care Med. 2007;176:858–64.

    Article  PubMed  Google Scholar 

  23. Moeller A, Diefenbacher C, Lehmann A, et al. Exhaled nitric oxide distinguishes between subgroups of preschool children with respiratory symptoms. J Allergy Clin Immunol. 2008;121:705–9.

    Article  PubMed  CAS  Google Scholar 

  24. Schultz A, Devadason SG, Savenije OE, Sly PD, Le Souëf PN, Brand PL. The transient value of classifying preschool wheeze into episodic viral wheeze and multiple trigger wheeze. Acta Paediatr. 2010;99:56–60.

    PubMed  CAS  Google Scholar 

  25. Meissner HC. Viral bronchiolitis in children. New Engl J Med. 2016;374:62–72.

    Article  PubMed  CAS  Google Scholar 

  26. Rodriguez R, Ramilo O. Respiratory syncytial virus: how, why and what to do. J Inf Secur. 2014;68:S115–8.

    Google Scholar 

  27. Raywood E, Lum S, Aurora P, Pike K. The bronchodilator response in preschool children: a systemic review. Pediatr Pulmonol. 2016;51:1242–50.

    Article  PubMed  Google Scholar 

  28. Bickel S, Popler J, Lesnick B, Eid N. Impulse oscillometry: interpretation and practical applications. Chest. 2014;146:841–7.

    Article  PubMed  Google Scholar 

  29. Borrego LM, Stocks J, Leiria-Pinto P, et al. Lung function and clinical risk factors for asthma in infants and young children with recurrent wheeze. Thorax. 2009;64:203–9.

    Article  PubMed  CAS  Google Scholar 

  30. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Sys Rev. 2014;6:CD001266.

    Google Scholar 

  31. Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet. 2017;389:211–24.

    Article  PubMed  Google Scholar 

  32. Zhang L, Mendoza-Sassi RA, Klassen TP, Wainwright C. Nebulized hypertonic saline for acute bronchiolitis: a systematic review. Pediatrics. 2015;136:687–701.

    Article  PubMed  Google Scholar 

  33. Maguire C, Cantrill H, Hind D, Bradburn M, Everard ML. Hypertonic saline (HS) for acute bronchiolitis: systematic review and meta-analysis. BMC Pulm Med. 2015;15:148.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Brooks CG, Harrison WN, Ralston SL. Association between hypertonic saline and hospital length of stay in acute viral bronchiolitis: a reanalysis of 2 meta-analyses. JAMA Pediatr. 2016;170:577–84.

    Article  PubMed  Google Scholar 

  35. Law KW, Ng KK, Yuen KN, Ho CS. Detecting asthma and bronchial hyperresponsiveness in children. Hong Kong Med J. 2000;6:99–104.

    PubMed  CAS  Google Scholar 

  36. Hartling L, Bialy LM, Vandermeer B, et al. Epinephrine for bronchiolitis. Cochrane Database Syst Rev. 2011;6:CD003123.

    Google Scholar 

  37. Fernandes RM, Bialy LM, Vandermeer B, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev. 2013;6:CD004878.

    Google Scholar 

  38. Hartling L, Fernandes RM, Bialy L, et al. Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis. BMJ. 2011;342:d1714.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Farley B, Spurling GK, Eriksson L. Del MarCB. Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev. 2014;10:CD005189.

    Google Scholar 

  40. Svedmyr J, Nyberg E, Thunqvist P, Asbrink-Nilsson E, Hedlin G. Prophylactic intermittent treatment with inhaled corticosteroids of asthma exacerbations due to airway infections in toddlers. Acta Paediatr. 1999;88:42–7.

    Article  PubMed  CAS  Google Scholar 

  41. Bacharier LB, Phillips BR, Zeiger RS, et al. Episodic use of an inhaled corticosteroid or leukotriene receptor antagonists in preschool children with moderate-to-severe intermittent wheezing. J Allergy Clin Immunol. 2008;122:1127–35.e8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Ducharme 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;360:339–53.

    Article  PubMed  CAS  Google Scholar 

  43. Valovirta E, Boza ML, Robertson CF, et al. Intermittent or daily montelukast versus placebo for episodic asthma in children. Ann Allergy Asthma Immunol. 2011;106:518–26.

    Article  PubMed  CAS  Google Scholar 

  44. 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;175:323–9.

    Article  PubMed  CAS  Google Scholar 

  45. American Academy of Pediatrics Committee on Infectious Diseases. American Academy of Pediatrics Bronchiolitis Guidelines Committee. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics. 2014;134:e620–38.

    Article  Google Scholar 

  46. Blanken MO, Rovers MM, Molenaar JM, et al. Respiratory syncytial virus and recurrent wheeze in healthy preterm infants. N Engl J Med. 2013;368:1791–9.

    Article  PubMed  CAS  Google Scholar 

  47. Mochizuki H, Kusuda S, Okada K, et al; Scientific Committee for Elucidation of Infantile Asthma. Palivizumab prophylaxis in preterm infants and subsequent recurrent wheezing. Six-year follow-up study. Am J Respir Crit Care Med. 2017;196:29–38.

  48. Andersen ZJ, Loft S, Ketzel M, et al. Ambient air pollution triggers wheezing symptoms in infants. Thorax. 2008;63:710–6.

    Article  PubMed  CAS  Google Scholar 

  49. Census and Statistics Department, Gov. of HKSAR. 2011 Population Census – Summary Results, 2012. Available at: http://www.census2011.gov.hk/pdf/summary-results.pdf. Accessed 07 June 2017.

  50. Kuehni CE, Strippoli MF, Low N, Brooke AM, Silverman M. Wheeze and asthma prevalence and related health-service use in white and south Asian pre-school children in the United Kingdom. Clin Exp Allergy. 2007;37:1738–46.

    Article  PubMed  CAS  Google Scholar 

  51. Netuveli G, Hurwitz B, Levy M, et al. Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis. Lancet. 2005;365:312–7.

    Article  PubMed  Google Scholar 

  52. Grad R, Morgan WJ. Long-term outcomes of early-onset wheeze and asthma. J Allergy Clin Immunol. 2012;130:299–307.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Morgan WJ, Stern DA, Sherrill DL, et al. Outcome of asthma and wheezing in the first 6 years of life: follow-up through adolescence. Am J Respir Crit Care Med. 2005;172:1253–8.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Phelan PD, Robertson CF, Olinsky A. The Melbourne Asthma Study: 1964-1999. J Allergy Clin Immunol. 2002;109:189–94.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong, SAR, China

    Ka-ka Siu, Shuk-yu Leung, Sum-yi Kong & Daniel Kwok-keung Ng

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All authors have participated in the concept and design; analysis and interpretation of data; drafting or revising of the manuscript, and that they have approved the manuscript as submitted.

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Correspondence to Daniel Kwok-keung Ng.

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Siu, Kk., Leung, Sy., Kong, Sy. et al. Management of Recurrent Preschool, Doctor-Diagnosed Wheeze. Indian J Pediatr 85, 658–666 (2018). https://doi.org/10.1007/s12098-017-2537-4

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  • DOI: https://doi.org/10.1007/s12098-017-2537-4

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