Managing preschool wheezing in the community

Wheeze is common in preschool-aged children. Most often these episodes are intermittent, and all that is necessary is intermittent bronchodilator therapy. However, quite often this group of children are treated with asthma therapies, such as inhaled corticosteroids with or without an established diagnosis of asthma. The preschool wheeze involves neutrophillic cytology with a degree of fixed airflow obstruction, and therefore it is unlikely to respond to standard asthma therapies. It is important that a proper diagnosis is established and discussed with the family, and that the only rationale for using a prophylactic therapy in preschool wheezers is to improve the quality of life for the child. Also, it should be remembered that this is not a disease-modifying therapy and does not stop the development of asthma in some of these children in late childhood.