Phenotype-Based Management of Recurrent Preschool Wheezing and Asthma

Acute wheezing episodes in preschool children are among the most common reason for unscheduled health care attendance globally, and the incidence of acute presentations has increased over the past 2 decades. Although it is recognized that wheezing disorders in preschool children are heterogeneous, incorporating several phenotypes, with distinct underlying pathophysiological mechanisms, the continuing morbidity suggests our current approach to preventing acute episodes is suboptimal. Recurrent wheeze exacerbations and poor symptom control contribute to a low lung function trajectory to adulthood and increased mortality and morbidity later in life from both respiratory and cardiovascular conditions. Effective treatment strategies to reduce acute exacerbations and improve symptom control are needed to prevent these poor long-term outcomes. The focus of this review was to summarize the evidence for the management of recurrent preschool wheeze to prevent acute episodes, emphasizing the importance of both accurate clinical phenotyping and the need to undertake investigations to identify biomarkers that can be used to guide treatment choice best suited to the child's phenotype. This approach will enable a move toward more personalized therapy, which may have a better response than our current approach, and allow us to reduce the health care burden and morbidity resulting from recurrent preschool wheeze.