Wheezing and asthma in early childhood – a PRACTALL consensus report

Klinika Gruźlicy, Chorób i Nowotworów Płuc Katedry Pulmonologii i Alergologii Uniwersytetu Medycznego w Łodzi
Wojewódzki Zespół Zakładów Opieki Zdrowotnej Centrum Leczenia Chorób Płuc i Rehabilitacji w Łodzi.
Kierownik Kliniki: prof. dr hab. n. med. Iwona Grzelewska-Rzymowska
Correspondence to: Iwona Grzelewska-Rzymowska, Klinika Gruźlicy, Chorób i Nowotworów Płuc Uniwersytetu Medycznego w Łodzi, ul. Okólna 181, 91-520 Łódź, tel.: 042 617 72 95, e-mail: klinika.tbc.um@wp.pl
Source of financing: Department own sources

Pediatr Med rodz Vol 5 Numer 3, p. 169-173, 193
ABSTRACT

Asthma is a serious global health problem, because people of all ages are affected by this illness. It was show that a one in three child has at least one episode of wheezing prior to there third birthday. That is why GINA report and other guidelines for diagnosis and treatment of wheezing in children were issued. One of them is PRACTALL consensus report as a guideline for clinical practice in Europe and in North America. In this report four different pattern of recurrent wheeze in paediatric population have been proposed: transient, nonatopic, persistent asthma and severe intermittent asthma. PRACTALL report underlying that age and triggers can be used to define different phenotypes. According to ERS TASK FORCE (2008) episodic and multiple trigger wheezes are recognized. Episodic wheeze is defined as wheeze in discrete episodes child being well between episodes. This phenotype is usually associated with viral respiratory tract infection. Among multiple triggers are different allergens, viruses, tobacco smoke. The PRACTALL report states that age is one of the strongest determinants of asthma phenotype in childhood and it is important to design diagnostic and management strategies based on age. In infants (0-2 years old) persistent symptoms is a major indicator of severity, in preschool children (3-5 years old) the asthma phenotypes are established basing the persistent wheeze during last year. If symptoms disappear between episodes of viral infections, doprowaviral asthma is the most appropriate diagnosis. In children with skin prick tests or in vitro test are positive the allergen-induced asthma should be recognized because atopy is a strong risk factor for asthma. In some children phenotype non-allergic asthma can be identified. An important risk factor for new-onset asthma in early adult life is pre-existing allergic rhinitis. Also bronchial hyperresponsiveness in non-asthmatic children at age 6 years showed increased risk asthma by 11 years.

Keywords: wheezing, asthma, viruses, phenotypes of asthma, PRACTALL report