Department of Pediatrics, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong, SAR, China.
Indian J Pediatr. 2018 Aug;85(8):658-666. doi: 10.1007/s12098-017-2537-4. Epub 2018 Jan 8.
Preschool wheeze occurs in half of the children before they reach 6 y of age and recurrence is also common. Recurrent preschool wheeze is classified as either typical or atypical. For typical recurrent preschool wheeze, the diagnoses are either asthma or bronchiolitis/bronchitis. Responsiveness to a properly administered bronchodilator confirms asthma, atopic or otherwise. All atypical preschool wheeze should be referred to pediatric respirologist for assessment. Lung function test by impulse oscillometry (IOS) before and after bronchodilator is helpful to confirm airway hyperresponsiveness, an essential feature of asthma. Assessment of atopy is important by either skin prick test or serum IgE level. Treatment of acute wheeze includes standard supportive care, bronchodilator for those diagnosed with asthma and hypertonic saline for those diagnosed as having acute bronchiolitis. Other treatments included nebulized adrenaline for acute bronchiolitis and systemic steroids for asthma. For those with significant respiratory distress, continuous positive airway pressure (CPAP) or heated humidified high flow should be considered. Daily or intermittent inhaled corticosteroid or intermittent montelukast would reduce asthma exacerbation rate. A significant proportion of preschool wheeze persists till school age. An early diagnosis of asthma would be important to allow early optimal management.
学龄前喘息发生于一半在 6 岁前的儿童，且复发也很常见。复发性学龄前喘息分为典型或非典型。对于典型的复发性学龄前喘息，诊断要么是哮喘，要么是细支气管炎/支气管炎。经适当给予支气管扩张剂后的反应性可确诊哮喘，无论是否存在特应性。所有非典型学龄前喘息均应转至儿科呼吸科医生进行评估。在支气管扩张剂治疗前后进行脉冲振荡肺功能测试（IOS）有助于确认气道高反应性，这是哮喘的一个基本特征。通过皮肤点刺试验或血清 IgE 水平进行特应性评估很重要。急性喘息的治疗包括标准支持性护理、对于诊断为哮喘的患者使用支气管扩张剂、对于诊断为急性细支气管炎的患者使用高渗盐水。其他治疗包括急性细支气管炎的雾化肾上腺素和哮喘的全身皮质类固醇。对于那些有明显呼吸窘迫的患者，应考虑持续气道正压通气（CPAP）或加热湿化高流量。每日或间歇性吸入皮质类固醇或间歇性孟鲁司特可降低哮喘恶化率。相当一部分学龄前喘息持续到学龄期。早期诊断哮喘对于进行早期最佳治疗非常重要。
