Demystifying controversies in preschool wheeze

Smith, Frank M; Saglani, Sejal

doi:10.1080/17476348.2023.2283128

Cited by 4 publications

(3 citation statements)

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“…Clinical phenotypes of wheeze may be overlapping and may change over time. 12 Understanding the underlying biology of different wheeze subtypes is crucial in order to understand which wheezing toddlers will develop asthma. This requires a more in-depth approach than solely counting blood eosinophils, as well as a collective effort to identify novel biomarkers using innovative approaches to optimize management of persistent wheeze.…”

Section: Of 3 |mentioning

confidence: 99%

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Editorial comment on “Limited clinical role of blood eosinophils in early life atopic disease: a mother‐child cohort study”

Vijverberg,

Rutjes,

Riggioni

2024

Pediatric Allergy Immunology

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Approximately one in three preschool children experience recurrent wheezing or other asthma-like symptoms, such as troublesome cough and breathlessness. 1 Different wheeze trajectories have been identified and may underline distinct pathophysiological mechanisms that might drive wheezing. 2,3 Although children with wheeze are at increased risk of developing asthma later in life, we still cannot accurately predict at an individual level which child will develop asthma and which child will only present with transient or isolated wheezing. There is a need for objective biomarkers that can be used in clinical practice to guide treatment and prevention strategies.Identifying these biomarkers would allow focused monitoring, early initiation of asthma therapy, prevent overtreatment and guide interventions to prevent asthma development.Blood eosinophil counts have been widely studied as asthma biomarkers. Eosinophils play an important role in driving type 2 inflammation in the airways. Blood eosinophilia is common in children with asthma, and it has also been associated with an increased risk of severe asthma attacks in preschool-aged children with moderate-tosevere recurrent wheeze. 4 One of the advantages of blood eosinophils counts lies in the simplicity of analysis, which is relatively easy and inexpensive, and the procedure is less invasive than the measurement of eosinophil counts in sputum or BAL/biopsies.

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Section: Of 3 |mentioning

confidence: 99%

“…To conclude, this study highlights the complexity of preschool wheezing. Clinical phenotypes of wheeze may be overlapping and may change over time 12 . Understanding the underlying biology of different wheeze subtypes is crucial in order to understand which wheezing toddlers will develop asthma.…”

mentioning

confidence: 99%

Editorial comment on “Limited clinical role of blood eosinophils in early life atopic disease: a mother‐child cohort study”

Vijverberg,

Rutjes,

Riggioni

2024

Pediatric Allergy Immunology

View full text Add to dashboard Cite

show abstract

“…Given the heterogeneity of wheezing illnesses in early life, with multi‐faceted risk factors and aetiology, and variable contributions from infections (viruses, bacteria and fungi), environmental exposures (allergens, pollutants, climate), genetic susceptibility, resulting in such marked differences in underlying pathology, we need to accept that a ‘one size fits all’ approach will not work. Just as treatments to manage acute wheezing episodes need to be targeted and personalised, 36 it is likely that strategies that will prevent progression to asthma will also need to be targeted to the individual child, their phenotype, genotype and endotype. If a targeted approach is not considered, there is a potential for causing harm.…”

Section: Unanswered Questions and Future Directionsmentioning

confidence: 99%

Preventing progression of preschool wheezing to asthma: Opportunities for intervention

Saglani

2024

Pediatric Allergy Immunology

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Recurrent wheezing in preschool children is heterogeneous and results from numerous genetic and environmental risk factors, which result in the same final clinical manifestation of acute episodes of wheezing but have distinct underlying mechanisms. Effective disease‐modifying approaches, therefore, need to target the pathways driving the symptoms. We have good evidence to show that targeting airway eosinophilia alone in early‐life preschool wheezing and using inhaled corticosteroids is not disease‐modifying. Although airway remodelling develops early in preschool wheezing, the challenge is identifying suitable treatments for structural airway changes. There is increasing evidence for the role of lower airway bacterial infection contributing to wheeze episodes, but clinical trials investigating the impact of targeted antibiotic treatment on disease modification are needed. There is also increasing data supporting an association between lower airway neutrophilia and wheezing in a subgroup of preschool children, but direct causation and the role of neutrophil function remain unknown. Finally, there is encouraging preliminary data for the role of inactivated mixed bacterial lysates in children with non‐allergic, infection‐associated wheeze episodes, but the impact on longer‐term outcomes and their mechanism of action is unknown. This review outlines a range of potential novel targets and approaches that may enable secondary prevention of asthma from preschool wheezing. In parallel, the potential for harm when interventions are introduced indiscriminately is highlighted. Some of the challenges that need to be addressed, including trial designs allowing tailored interventions, the need for non‐invasive biomarkers for targeted interventions, and ensuring extended and long‐term follow‐up after intervention, are highlighted.

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The importance of objective confirmation of airway obstruction in preschool wheezing

Rodríguez‐Martínez,

Sossa‐Briceño,

Nino

2024

Pediatric Pulmonology

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Demystifying controversies in preschool wheeze

Cited by 4 publications

References 50 publications

Editorial comment on “Limited clinical role of blood eosinophils in early life atopic disease: a mother‐child cohort study”

Editorial comment on “Limited clinical role of blood eosinophils in early life atopic disease: a mother‐child cohort study”

Preventing progression of preschool wheezing to asthma: Opportunities for intervention

The importance of objective confirmation of airway obstruction in preschool wheezing

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