Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.
National Heart & Lung Institute, Imperial College London, London, UK.
Expert Rev Respir Med. 2023 Jul-Dec;17(11):1023-1031. doi: 10.1080/17476348.2023.2283128. Epub 2023 Dec 26.
Wheezing disorders in preschool children are common. Current treatment approaches assume all preschool wheezers are the same and will respond to a short course of oral corticosteroids (OCS) during acute attacks and subsequent maintenance inhaled corticosteroids (ICS) to prevent future attacks. But we have increasing evidence showing preschool wheezing disorders are markedly heterogeneous and the response to corticosteroids either during acute attacks or as maintenance therapy can be variable between patients and is determined by disease severity and underlying pathological phenotype.
The aim of this review is to discuss recent evidence which will help to explain a few critical pathophysiological concepts that are often misunderstood, thus helping to demystify the controversies that often surround preschool wheezing disorders and can contribute to ineffective management.
Preschool wheezing disorders are distinct from school-age allergic asthma. There is little evidence to support the use of oral corticosteroids for acute attacks. A staged approach to confirm the diagnosis, and objective tests to determine the pathological phenotype of preschool wheeze is essential prior to initiating maintenance therapy to control symptoms and prevent attacks in children with recurrent preschool wheeze.
学龄前儿童的喘息障碍很常见。目前的治疗方法假定所有学龄前喘息患儿都是相同的，并且在急性发作期间会对短期口服皮质类固醇（OCS）有反应，随后使用吸入皮质类固醇（ICS）维持治疗以预防未来发作。但我们有越来越多的证据表明，学龄前喘息障碍明显具有异质性，皮质激素在急性发作期间或维持治疗期间的反应在患者之间可能存在差异，并且由疾病严重程度和潜在的病理表型决定。
本综述的目的是讨论最近的证据，这些证据将有助于解释一些经常被误解的关键病理生理概念，从而有助于揭开经常围绕学龄前喘息障碍的争议，并有助于管理不善。
学龄前喘息障碍与学龄期过敏性哮喘不同。几乎没有证据支持使用口服皮质类固醇治疗急性发作。在开始维持治疗以控制症状和预防反复发作的学龄前儿童喘息发作之前，需要采用分阶段的方法来确诊，并采用客观的测试来确定学龄前喘息的病理表型。
