title: Classification and pharmacological treatment of preschool wheezing: changes since 2008.
abstract: Since the publication of the European Respiratory Society Task Force report in 2008, significant new evidence has become available on the classification and management of preschool wheezing disorders. In this report, an international consensus group reviews this new evidence and proposes some modifications to the recommendations made in 2008. Specifically, the consensus group acknowledges that wheeze patterns in young children vary over time and with treatment, rendering the distinction between episodic viral wheeze and multiple-trigger wheeze unclear in many patients. Inhaled corticosteroids remain first-line treatment for multiple-trigger wheeze, but may also be considered in patients with episodic viral wheeze with frequent or severe episodes, or when the clinician suspects that interval symptoms are being under reported. Any controller therapy should be viewed as a treatment trial, with scheduled close follow-up to monitor treatment effect. The group recommends discontinuing treatment if there is no benefit and taking favourable natural history into account when making decisions about long-term therapy. Oral corticosteroids are not indicated in mild-to-moderate acute wheeze episodes and should be reserved for severe exacerbations in hospitalised patients. Future research should focus on better clinical and genetic markers, as well as biomarkers, of disease severity.
authors: Isala Hospital, Zwolle.
authors: Paul L P
authors: PL
authors: Brand
authors: Daan
authors: D
authors: Caudri
authors: Ernst
authors: E
authors: Eber
authors: Erol A
authors: EA
authors: Gaillard
authors: Luis
authors: L
authors: Garcia-Marcos
authors: Gunilla
authors: G
authors: Hedlin
authors: John
authors: J
authors: Henderson
authors: Claudia E
authors: CE
authors: Kuehni
authors: Peter J F M
authors: PJ
authors: Merkus
authors: Soren
authors: S
authors: Pedersen
authors: Arunas
authors: A
authors: Valiulis
authors: Göran
authors: G
authors: Wennergren
authors: Andrew
authors: A
authors: Bush
mesh_terms: D000085:Acetates / Q000008:administration & dosage; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology*; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003521:Cyclopropanes; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007391:International Cooperation; D017410:Practice Guidelines as Topic; D015272:Pulmonary Medicine / Q000592:standards; D011804:Quinolines / Q000008:administration & dosage; D012135:Respiratory Sounds / Q000145:classification / Q000175:diagnosis*; D013440:Sulfides
chemical_list: D000085:Acetates; D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D015415:Biomarkers; D003521:Cyclopropanes; D005938:Glucocorticoids; D011804:Quinolines; D013440:Sulfides; C093875:montelukast