title: Diagnosis, management, and prognosis of preschool wheeze.
abstract: Preschool children (ie, those aged 5 years or younger) with wheeze consume a disproportionately high amount of health-care resources compared with older children and adults with wheeze or asthma, representing a diagnostic challenge. Although several phenotype classifications have been described, none have been validated to identify individuals responding to specific therapeutic approaches. Several risk factors related to genetic, prenatal, and postnatal environment are associated with preschool wheezing. Findings from several cohort studies have shown that preschool children with wheeze have deficits in lung function at 6 years of age that persisted until early and middle adulthood, suggesting increased susceptibility in the first years of life that might lead to persistent sequelae. Daily inhaled corticosteroids seem to be the most effective therapy for recurrent wheezing in trials of children with interim symptoms or atopy; intermittent high-dose inhaled corticosteroids are effective in moderate-to-severe viral-induced wheezing without interim symptoms. The role of leukotriene receptor antagonist is less clear. Interventions to modify the short-term and long-term outcomes of preschool wheeze should be a research priority.
authors.affiliation: Clinical Research and Knowledge Transfer on Childhood Asthma Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada; Department of Paediatrics, University of Montreal, Montreal, QC, Canada; Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada. Electronic address: francine.m.ducharme@umontreal.ca.
authors.forename: Francine M
authors.initials: FM
authors.lastname: Ducharme
authors.affiliation: Clinical Research and Knowledge Transfer on Childhood Asthma Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada; Department of Paediatrics, University of Montreal, Montreal, QC, Canada.
authors.forename: Sze M
authors.initials: SM
authors.lastname: Tse
authors.affiliation: Clinical Research and Knowledge Transfer on Childhood Asthma Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada.
authors.forename: Bhupendrasinh
authors.initials: B
authors.lastname: Chauhan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D002675:Child, Preschool; D017281:Cost of Illness; D003937:Diagnosis, Differential; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007223:Infant; D010641:Phenotype; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000209:etiology; D011379:Prognosis; D012135:Respiratory Sounds / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents