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.
ISI Document Delivery No.: AE8OT Times Cited: 5 Cited Reference Count: 43 Brand, Paul L. P. Caudri, Daan Eber, Ernst Gaillard, Erol A. Garcia-Marcos, Luis Hedlin, Gunilla Henderson, John Kuehni, Claudia E. Merkus, Peter J. F. M. Pedersen, Soren Valiuis, Arunas Wennergren, Goeran Bush, Andrew NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust; Imperial College London A. Bush was supported by the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London. 6 EUROPEAN RESPIRATORY SOC JOURNALS LTD SHEFFIELD EUR RESPIR J
Brand, P. L. P., Caudri, D., Eber, E., Gaillard, E. A., Garcia-Marcos, L., Hedlin, G., Henderson, J., Kuehni, C. E., Merkus, P., Pedersen, S., Valiuis, A., Wennergren, G., & Bush, A. (2014). Classification and pharmacological treatment of preschool wheezing: changes since 2008
. European Respiratory Journal. Supplement
(4), 1172-1177. https://doi.org/10.1183/09031936.00199913