Management of Recurrent Preschool, Doctor-Diagnosed Wheeze
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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.
KeywordsAsthma Bronchiolitis Bronchitis Diagnosis Management Preschool Wheeze
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- 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.
- 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.
- 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.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.Google Scholar
- 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.
- 26.Rodriguez R, Ramilo O. Respiratory syncytial virus: how, why and what to do. J Inf Secur. 2014;68:S115–8.Google Scholar
- 30.Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Sys Rev. 2014;6:CD001266.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
- 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
- 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.CrossRefGoogle 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.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.