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Role of oral corticosteroids in the treatment of acute preschool wheeze
  1. Shaun O' Hagan1,2,
  2. Hannah Norman-Bruce2,
  3. Michael Shields2,3,
  4. Helen Elizabeth Groves1,2
  1. 1 Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, UK
  2. 2 Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast School of Medicine, Belfast, UK
  3. 3 Paediatric Respiratory Medicine, Royal Belfast Hospital for Sick Children, Belfast, Belfast, UK
  1. Correspondence to Dr Helen Elizabeth Groves, Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, Belfast, UK; h.groves{at}qub.ac.uk

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In the United Kingdom (UK), preschool wheeze is usually defined as occurring in children aged one to five years old. Prevalence studies report a third of children experience at least one wheeze episode before the age of three, rising to half of all children by the age of six.1 These acute episodes represent a considerable healthcare burden, causing significant morbidity for affected children, parental stress and reduced productivity; with annual UK healthcare costs in-excess-of £53 million.2 3

The multifactorial nature of acute preschool wheeze (APSW) episodes are such that, in reality, this is an umbrella term; encompassing several phenotypes rather than a singular entity.1 In 2008, the European Respiratory Society Task Force recommended clinical phenotype categorisation as episodic viral wheeze (EVW) or multiple trigger wheeze (MTW).4 EVW is more common; typically associated with viral respiratory infections and minimal interval symptoms,4 whereas children with MTW are more commonly atopic, may have a family history of asthma, experience interval symptoms and are more likely to develop asthma.5 However, considerable debate exists over the usefulness of such terminology; given categorisation does not account for wheeze severity or frequency, and many children show phenotypic cross-over.5–7 There is also limited evidence these phenotypes predict longitudinal wheeze pattern or therapeutic response.7

Management approaches to APSW are not phenotype specific and are often extrapolated from algorithms designed for older children with asthma.8 9 National Institute for Health and Care Excellence (NICE) as well as joint British Thoracic Society and Scottish Intercollegiate Guidelines Network guidelines address the management of acute asthma and wheeze in children.8 9 In children with severe symptoms requiring hospitalisation, oral corticosteroids (OCS) are advised, as part of care escalation.9 However, in preschool children with mild-to-moderate wheeze, current guidance lacks clarity for the prescription of OCS. …

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Footnotes

  • X @DrShaunKiwi

  • Contributors SOH, HN-B and HEG drafted and revised serial manuscript versions. MS reviewed and edited the manuscript, providing respiratory expertise.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.