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Clinical Review

Managing wheeze in preschool children

BMJ 2014; 348 doi: (Published 04 February 2014) Cite this as: BMJ 2014;348:g15

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Re: Managing wheeze in preschool children

I thank Bush, Grigg and Saglani for their extremely helpful article on preschool wheeze (1). One implication would seem to be that children on established prophylactic treatment for multiple trigger wheeze should have trials off it at some point, to ascertain whether they have spontaneously outgrown their symptoms.

I would welcome any pragmatic advice the authors can offer, from their clinical experience, about the timing of such trials of treatment breaks - would this be best done on a regular basis such as every year or two, or when the child reaches a particular age at which symptoms are likely to have either resolved or progressed to asthma? One important subset to look at here, of course, would be the children on leukotriene inhibitors for MTW who subsequently progress to asthma; presumably at some point they need to be treated as established asthmatics and changed to inhaled corticosteroids, and I am wondering at what sort of age this possibility should be explored for children on leukotriene inhibitor prophylaxis for MTW.

(1) Bush A, Grigg J, Saglani S. Managing wheeze in preschool children. BMJ 2014;348:g15

Competing interests: No competing interests

15 February 2014
Sarah C Vaughan
Box Surgery