Table 3– 2013 consensus statement on classification and management of preschool wheezing disorders
Distinction of preschool wheeze phenotypesThe distinction between EVW and MTW is not clear in all patients
Some children retain a consistent pattern of EVW or MTW, but symptom patterns change over time in many patients and their airway pathology remains unclear
Severity and frequency of episodes seem to be at least as important to distinguish between children as the distinction between EVW and MTW
Daily controller therapyIn children with MTW, ICS are the first choice for daily controller therapy
In children with EVW, daily therapy may be considered with either ICS or montelukast if:
 the attacks are severe (requiring hospital admission or systemic corticosteroids); or
 the attacks are frequent; or
 the clinician suspects that interval symptoms are being under reported
Any controller therapy should be viewed as a treatment trial, with scheduled follow-up
 Discontinue treatment if there has been no benefit
 Take favourable natural history into account: taper down to lowest effective dose, and discontinue treatment if the child has been symptom-free for 3 months on low-dose therapy
Treatment of acute episodesOral corticosteroids are not indicated in preschool children with an exacerbation of viral wheeze who do not need to be admitted to hospital
Oral corticosteroids are indicated only in preschool children admitted to hospital with very severe wheeze; even in this group, evidence to support the use of prednisolone is not robust
  • EVW: episodic viral wheeze; MTW: multiple-trigger wheeze; ICS: inhaled corticosteroids.