Which Wheezing Preschoolers Should be Treated for Asthma?

Wheezing disorders in children younger than 5 years are common, but lack of clarity remains about which children should be treated to prevent symptoms and acute episodes. The aim of this review was to discuss a practial approach to deciding which children younger than 5 years with asthma should be treated, and if so, with which strategy. The importance of having a clear definition of asthma for this age group, determined by a collection of presenting respiratory symptoms, without assumptions about underlying mechanisms is addressed. Subsequent consideration should be given to timing, severity, and frequency of symptoms, together with assessment of objective biomarkers, including aeroallergen sensitization and blood eosinophils, to inform whether or not a preschooler with recurrent wheezing requires treatment. Numerous unanswered questions remain about the optimal management of nonallergic preschool wheezing and asthma, and areas of specific unmet need and future directions for research are highlighted. (c) 2021 American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2021;9:2611-8)

Automated summary

This review discusses the practical approach to deciding which children under 5 years with asthma should be treated, based on the severity, duration of symptoms, and evaluation of objective biomarkers. The optimal management of nonallergic preschool wheezing and asthma still presents numerous unanswered questions, highlighting the need for future research.