The use of inhaled corticosteroid in preschool wheezers: what's the point today?

To distinguish between these different phenotypes of wheezing, and consequently choose therapy represents a major challenge for pediatricians.Transient wheezers conditions do not improve with maintenance treatment with ICS. On the other hand they are definitely useful in children with wheeze/asthma.Increasing evidence is in favor of the potential role of leukotriene receptor antagonists in preschool children with recurrent wheezing.Oral steroid has been demonstrated not to be indicated to control acute wheezing, unless severe disease is expected in non-atopic children.The early phenotyping of preschool wheezers, upon which the appropriate treatment should be based, represents a challenging issue in the paediatric practice.Wheezing and cough are frequently observed in preschool children, in many cases related to a respiratory tract infection.These situations represent a major challenge in the practice of paediatricians since, at present, it is very hard to distinguish between the different phenotypes which underlie an apparently similar clinical presentation.In fact, among the preschool children who wheeze, at least two different groups can be identified, i.e. children who wheeze on the basis of a viral trigger and those who respond to multiple triggers, the latter being somehow referable to the asthmatic wheezing [1].The temporal pattern for viral wheezing is commonly reported as episodic, with periods free of symptoms between episodes, and is reported to be concomitant with a viral infection of the airways.In contrast, children with multiple trigger wheezing, though being highly responsive to viral infections which represent the most common trigger for their symptoms, also wheeze when exposed to a variety of other triggers, such as exercise or allergens [1].Cohort studies have suggested that some clinical characteristics can help in distinguishing among the different phenotypes of preschool wheezers [2], but the application of such parameters cannot be considered c