A Case-Based Review on the Diagnosis and Treatment Options for Recurrent Wheezing and Asthma in Preschool Children

  • Maleewan KitcharoensakkulEmail author
  • Leonard B. Bacharier
Allergic Asthma (DES Larenas-Linnemann de Martinez, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Allergic Asthma


Purpose of review

To summarize the recent evidence on the various wheezing patterns in early life and provide a case-based review with insights into clinical application of individualized therapy in preschool children with recurrent wheezing.

Recent findings

Preschool wheezing is often characterized predominantly by the risk domain with exacerbations and relatively limited impairment. In children with intermittent disease and a positive Modified Asthma Predictive Index, intermittent therapy with inhaled corticosteroids (ICSs) should be considered as an initial therapy to prevent exacerbations. Early administration of azithromycin at the onset of lower respiratory tract infections (LRTIs) reduces the risks of progression to severe illnesses in children who have a history of recurrent severe LRTIs, and more information is needed regarding the risks of developing drug-resistant organisms. In preschool children with mild persistent asthma, allergic sensitization to aeroallergens and absolute eosinophil count can help identify children most likely to have a good response to daily ICS.


Recent clinical trials in preschool children with severe episodic wheezing and persistent asthma have made a significant impact on the approach for the care of these children, particularly with evidence directing individualized approaches based on specific clinical features and biomarkers.


Recurrent wheezing Preschool Asthma Phenotypes 


Compliance with ethical standards

Conflict of interest

Leonard Bacharier reports personal fees from Aerocrine, personal fees from GlaxoSmithKline, personal fees from Genentech/Novartis, personal fees from Merck, personal fees from DBV Technologies, personal fees from Teva, personal fees from Boehringer Ingelheim, personal fees from AstraZeneca, personal fees from WebMD/Medscape, personal fees from Sanofi/Regeneron, personal fees from Vectura, and personal fees from Circassia outside the submitted work. Maleewan Kitcharoensakkul declares no conflicts of interest relevant to this manuscript.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Maleewan Kitcharoensakkul
    • 1
    Email author
  • Leonard B. Bacharier
    • 1
  1. 1.Division of Allergy, Immunology and Pulmonary Medicine, Department of PediatricsWashington University School of MedicineSt. LouisUSA

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