Preschool Recurrent Wheezing: Insights from the NHLBI’s asthma research networks

Published Online: January 2016

Recurrent wheezing in preschool children is a common clinical problem, which exerts a significant burden on those affected, their families, society, and the health-care system. There is a need for evidence-based recommendations to direct the management of preschool children with recurrent wheezing. Until recently, however, the management of these children has been complicated by a lack of high quality clinical trials performed in this specific age group. To fill this knowledge gap, the NHBLI’s asthma research networks have performed a series of clinical trials in an effort to provide practitioners with guidance on appropriate management strategies.

In a review recently published in The Journal of Allergy and Clinical Immunology: In-Practice (JACI), Beigelman and Bacharier summarize the findings and clinical implications derived from studies performed by the NHBLI’s Childhood Asthma Research and Education (CARE) Network (1999-2009) and the AsthmaNet (2009-present).  These studies have changed the way we treat asthma among preschool children. The studies established daily-inhaled corticosteroids (ICS) in toddlers at high risk for subsequent asthma as an effective approach for the prevention of exacerbations and symptom reduction. However, daily ICS therapy does not have long-term disease-modifying properties. Treatment with intermittent high dose ICS was demonstrated to be an effective alternative approach to daily low dose ICS for preventing severe episodes in toddlers with intermittent, but significant wheeze, at high risk for asthma defined by a positive modified asthma predictive index. In addition, post-hoc results from these studies have helped to recognize the need for large randomized trials to determine the role of oral corticosteroids as a treatment for acute episodic wheeze in young children.

Research supported by the NHLBI’s asthma research networks over the past 15+ years, along with substantial contributions from other investigative groups, has advanced the knowledge base for treatment in this age group.  These studies highlight the necessity of age-group specific trials rather than extrapolation from studies in older children and provide practitioners with high quality evidence to guide treatment decisions.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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