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Paediatric Pulmonology and Allergology
2008 October, Vol. XI, No. 2 (3911-3939)
ERS TASK FORCE REPORT: DEFINITION, ASSESSMENT AND TREATMENT OF WHEEZING DISORDERS IN PRESCHOOL CHILDREN – AN EVIDENCE BASED APPROACH
Paul L P Brand*, Eugenio Baraldi, Hans Bisgaard, Attilio Boner, Jose A Castro Rodriguez, Adnan Custovic, Jacques de Blic, Johan C de Jongste, Ernst Eber, Mark L Everard Urs Frey, Monika Gappa, Luis Garcia-Marcos, Jonathan Grigg, Warren Lenney, Peter LeSoeuf, Sheila McKenzie, Peter J F M Merkus, Fabio Midulla, James Y Paton, Giorgio Piacentini, Petr Pohunek, Giovanni Rossi, Paul Seddon, Michael Silverman, Peter D Sly, Stephen Stick, Arunas Valiulis, Wim M C van Aalderen, Johannes H Wildhaber, Goran Wennergren, Nicola Wilson, Zorica Zivkovic, Andrew Bush
* Princess Amalia Children’s Clinic, Isala klinieken, PO Box 10400, 8000 K Zwolle, the Netherlands
There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. This Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well in 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 on causative factors and treatment is useful. Exposure to tobacco smoke should be avoided. Allergen avoidance may be considered when sensitization has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple trigger wheeze but benefits are often small. Monteluka st 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 randomized controlled trials with clear description of patients are needed to improve our recommendations on the treatment of these common syndromes (European Respiratory Journal 2008; 32(4): 1096–110; http://www.ersnet.org).