Lower airway microbiota associates with inflammatory phenotype in severe preschool wheeze

Acute wheeze in preschool children accounts for more than 75% of pediatric health care attendances for wheeze/asthma in the United Kingdom.1 The high morbidity suggests current therapeutic strategies are failing. Preschool wheezers are heterogeneous; many have a disease course clinically distinct from that of childhood type 2–mediated allergic asthma.2 However, the pathologic mechanisms underpinning preschool wheeze are poorly understood. Treatment is currently determined by clinical phenotype.1 Episodic viral wheezers (EVWs) are predominantly prescribed intermittent therapies, and multiple-trigger wheezers (MTWs) are predominantly prescribed maintenance inhaled corticosteroids.