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Bacteria in the respiratory tract and wheeze in children

BMJ 2010; 341 doi: (Published 04 October 2010) Cite this as: BMJ 2010;341:c4836
  1. Jakob P Armann, clinical research fellow,
  2. Erika von Mutius, professor of paediatrics
  1. 1Allergy/Pulmonology, University Children’s Hospital, 80337 Muenchen, Germany
  1. jakob.armann{at}

Colonisation is more common in symptomatic children, but causation is not established

In the linked cohort study (doi:10.1136/bmj.c4978), Bisgaard and colleagues assess the association between wheezy symptoms in young children and the presence of bacteria in the airway.1 Lower respiratory tract illnesses presenting with cough, shortness of breath, or wheeze are common in preschool years.2 It has been proposed that, for the management of preschool wheeze, a distinction is made between episodic and multiple trigger wheeze.3 Episodic wheeze is defined as wheeze in discrete episodes of up to two to four weeks’ duration, usually triggered by a viral infection, and with the child being well in between. In multi-trigger wheeze, the child has distinct episodes of wheeze but also has intermittent symptoms, such as cough and wheeze at night or in response to exercise, crying, laughter, mist, and cold air, between these episodes. Viral infections are again the most common triggers, but multi-trigger wheeze is often associated with allergic features, and many children with preschool multi-trigger wheeze progress to chronic asthma. Current guidelines recommend the use of bronchodilators for wheezing episodes.3 Children with multi-trigger wheeze may also benefit from inhaled corticosteroids and leukotriene receptor agonists. Antibiotics have …

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