Paeds Vivas · respiratory-sleep-and-airway
Recurrent wheeze in preschool children — branching viva
Branching viva from the definition and phenotype classification of preschool wheeze, through the Asthma Predictive Index and atopy risk stratification, the phenotype-matched preventive pharmacology and its trial evidence, the acute severe attack, and the exclusion of the red-flag mimics.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in a general clinic and emergency department. The consultant asks you to talk through four preschoolers: a 2-year-old with six colds-associated wheeze episodes this year who is well between them, a 4-year-old with wheeze on exercise and cold air as well as colds who has eczema and a father with asthma, a 3-year-old in a severe acute attack with SpO2 of 90 percent, and an 18-month-old with a monophonic wheeze since choking on a nut a month ago.
Station opening
Examiner: "Define recurrent preschool wheeze and reproduce the phenotype classification." [2]
Strong candidate (must-hit)
- Defines recurrent preschool wheeze as a descriptive umbrella — repeated wheeze in a child under six — deliberately not the diagnosis 'asthma'; reproduces the ERS temporal phenotypes (episodic viral wheeze with discrete colds-associated attacks and well intervals, versus multiple-trigger wheeze with interval symptoms provoked by exercise, allergen, and cold air); adds that the phenotypes overlap, can switch over time, and guide rather than dictate treatment, and that the Tucson trajectories (transient early, late-onset, persistent) explain why most early wheeze remits. [2]
Weak candidate
- "It's just toddler asthma." [2]
References6ShowHide
- [2]Brand PL; Baraldi E; Bisgaard H; Boner AL; Castro-Rodriguez JA; Custovic A; et al Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J, 2008.PMID 18827155
- [3]Castro-Rodríguez JA; Holberg CJ; Wright AL; Martinez FD A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med, 2000.PMID 11029352
- [4]Guilbert TW; Morgan WJ; Zeiger RS; Mauger DT; Boehmer SJ; Szefler SJ; et al Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med, 2006.PMID 16687711
- [5]Ducharme FM; Lemire C; Noya FJ; Davis GM; Alos N; Leblond H; et al Preemptive use of high-dose fluticasone for virus-induced wheezing in young children. N Engl J Med, 2009.PMID 19164187
- [7]Zeiger RS; Mauger D; Bacharier LB; Guilbert TW; Martinez FD; Lemanske RF Jr; et al Daily or intermittent budesonide in preschool children with recurrent wheezing. N Engl J Med, 2011.PMID 22111718
- [8]Panickar J; Lakhanpaul M; Lambert PC; Kenia P; Stephenson T; Smyth A; et al Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med, 2009.PMID 19164186