Recent advances in the management of pre-school wheeze

Pre-school wheeze is very common and often difficult to treat. Most children do not require any investigations, only a detailed history and physical examination to ensure an alternative diagnosis is not being missed; the differential diagnosis, and hence investigation protocols for the child in whom a major illness is suspected, shows geographical variation. The pattern of symptoms should be divided into episodic viral and multiple trigger to guide treatment, and the pattern of symptoms re-assessed regularly. Attention to the proper use of spacers, and adverse environmental exposures such as tobacco smoke exposure, is essential. There are no disease-modifying therapies, so therapy is symptomatic. This paper reviews recent advances in treatment, specifically new data on the place of leukotriene receptor antagonists, prednisolone for acute attacks of wheeze and antibiotics, and proposes treatment protocols for the two types of wheeze.