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Clinical Review

Managing wheeze in preschool children

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g15 (Published 04 February 2014) Cite this as: BMJ 2014;348:g15

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Re: Managing wheeze in preschool children

The Editor
British Medical Journal
Sir /Ma’am
Our complements to the author who has brought a very important and pertinent topic for the readers . Respiratory disorders are affecting many million childrens on the globe . And the etiopathogenesis is still elusive.,the treatment therefore all the more becomes debatable issue;.One single strong guideline can not be effective to handle this global phenomena. If one takes the example of wheeze in childhood the article by Erwin1 w. Gelfand clearly explains that the pediatric asthma is a different disease. The fact that allergic asthma often begins in early childhood but the natural course of the disease can follow several pathways. asthma in early life may also differ from asthma in childhood. The infants appear less responsive to inhaled Glucocorticoids, and the inflammatory response2, if present, may be neutrophilic in nature
The initiation phase of the disease/condition occurs at a critical time-point in life with early allergen exposure and viral infections interplay with genetic susceptibility, setting the stage for future outcomes. This can be very much seen in Study by Meike Wo¨Rdemann and colleagues confirming the existence of different associations between helminth infections and atopic diseases, the nature of which appears to depend on the type of helminth infection and atopic disease studied. Also, the time of worm infestation seems to play a role as suggested by study3 .
Recently published review 4 also recommends
a) Oral Corticosteroids (OCS ) should be administered in preschool children (when all the first three condition meets )
1. Acute wheezing only,
2. Severely Ill
3.In the hospital by specialists;
OCS is not a community medication.

b) Intermittent use of high-dose inhaled corticosteroids (ICS) for acute wheeze is not generally recommended.
c) High-Dose ICS may be tried in individual basis, particularly in children receiving multiple courses of oral corticosteroids (ocs)
d) Regular treatment with ics is not effective to prevent episodic viral wheeze.
e) Regular treatment with ics may be at least partially effective in the prevention
Of multiple-trigger wheeze.

Thus with this much significant heterogeneity of the disease in children should always be kept in view before prescring any medication .
The treatment should be individualized and tailored to the patients need.

1. Erwin w. Gelfand. Pediatric asthma a different disease Proc Am Thorac Soc 2009 ;6. : 278–282.
2.Marguet c, and colegues Bronchoalveolar cell profiles in children with asthma, infantile wheeze, chronic cough, or Cystic fibrosis. Am j respir crit care med 1999;159:1533–1540.

3 Meike Wo¨Rdemann, and collegues Association of atopy, asthma, allergic rhinoconjunctivitis, Atopic dermatitis and intestinal helminth infections in cuban
Children Tropical Medicine And International Health 2008 ;13 :180–186

4. Fernando M. De Benedictis and Andrew Bush .Corticosteroids in respiratory diseases in children, Am J Respir Crit Care Med, 2012; 185:12–23.

Best regards.

Competing interests: No competing interests

24 May 2014
U C OJHA
pulmonologist
DR SHRUTI VIRMANI ,MD (PEDIATRICS),SPEICALIST GRADE 1 ESIC HOSPITAL BASAIDARAPUR,DR. DEEPTI AWASTHY OJHA, BSc,MBBS Medical Officer(C) NITRD NEW DELHI
MD,FCCP.
ESIC HOSPITAL BASAI DARAPUR .NEW DELHI