TY - JOUR T1 - Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach JF - European Respiratory Journal JO - Eur Respir J SP - 1096 LP - 1110 DO - 10.1183/09031936.00002108 VL - 32 IS - 4 AU - P. L. P. Brand AU - E. Baraldi AU - H. Bisgaard AU - A. L. Boner AU - J. A. Castro-Rodriguez AU - A. Custovic AU - J. de Blic AU - J. C. de Jongste AU - E. Eber AU - M. L. Everard AU - U. Frey AU - M. Gappa AU - L. Garcia-Marcos AU - J. Grigg AU - W. Lenney AU - P. Le Souëf AU - S. McKenzie AU - P. J. F. M. Merkus AU - F. Midulla AU - J. Y. Paton AU - G. Piacentini AU - P. Pohunek AU - G. A. Rossi AU - P. Seddon AU - M. Silverman AU - P. D. Sly AU - S. Stick AU - A. Valiulis AU - W. M. C. van Aalderen AU - J. H. Wildhaber AU - G. Wennergren AU - N. Wilson AU - Z. Zivkovic AU - A. Bush Y1 - 2008/10/01 UR - http://erj.ersjournals.com/content/32/4/1096.abstract N2 - There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting β2-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes. ER -