Better Management Needed for Childhood Wheeze

More concordance in terminology and care is needed for better management and diagnosis of preschool wheeze, according to a new qualitative study of parents’ views and experiences.1

“This research demonstrates an urgent need for preschool wheeze management policies and treatment pathways that are evidence-based and co-developed with parents. We have shown that use of investigations such as blood or allergy tests would be acceptable to parents, if they were shown to be helpful in guiding more effective and timely treatments,” senior investigator Gemma Heath, PhD, health psychologist and senior lecturer, Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom, said in a statement.2

Preschool wheeze often resembles asthma and affects approximately 30–40% of children under 6 years of age. The episodes of wheezing or breathlessness are often triggered by viral infections or allergies and do not necessarily indicate asthma.2

Heath and colleagues team interviewed affected parents and carers about their experiences with navigating preschool wheeze, as there is currently no diagnostic pathway or definitive management guidelines for preschool wheeze. They found multiple concerns and problems at different levels of management.1

One source of confusion was inconsistent terminology used by doctors and differing diagnoses of asthma, suspected asthma, viral wheeze and allergy. Parents reported frustration at the lack of definitive diagnosis or “mystery” causes, apparent lacks of general practitioner knowledge, and sometimes false reassurance that the wheeze was viral rather than asthma.

“Preschool wheeze has significant impact on young children’s and their parents’ lives. Our research, involving parents with lived experience, will inform future studies to improve the care and reduce the impact of preschool wheeze on the already-stretched emergency health services in the UK” investigator Prasad Nagakumar, MBBS, MD, Consultant Respiratory Pediatrician, Birmingham Children’s Hospital, and Honorary Associate Professor, Department of Inflammation and Ageing, University of Birmingham, added.2

Investigators also found that investigative tests would not be performed until after multiple hospitalizations, delaying identification of what caused the wheeze and appropriate treatment.1 In the study, parents welcomed the idea of timely tests but did not want to subject children to repeated testing. Concerning treatment with steroid and salbutamol inhalers, similarly to asthma, parents were amenable to the medications although they had concerns about short and long-term adverse events.

Parents reported significant psychological impacts of children being admitted to hospitals, with some missing work or giving up work to care for their child while experiencing high levels of anxiety. Others felt unable to go on international family vacations due to concerns about healthcare access in the case oof a wheeze attack. Overall, parents reported being “terrified” while observing preschool wheeze attacks.

In accordance with a lack of confidence in general practitioner knowledge, most parents preferred hospital care than at private clinics. However, this care can be expensive and burdensome for the family as a whole.

“Parents’ views highlight the problem of diagnosing and treating preschool wheeze at multiple system levels. To improve management and ensure that services for children with preschool wheeze are effective, there is an urgent need for consistent terminology, a unified approach to guide investigations and treatments and for upskilling healthcare professionals in primary and secondary care,” Heath and colleagues wrote.1

REFERENCES

1. Wajid LMA, Saglani S, Nagakumar P, Heath G. Managing preschool wheeze: a qualitative study of parents’ views and experiences. Arch. Dis. Child. Published online December 11, 2024. doi: 10.1136/archdischild-2024-327781

2. Aston University and Birmingham Children’s Hospital study shows diagnosis and treatment of preschool wheeze needs improvement. News release. Aston University. January 13, 2025. https://www.eurekalert.org/news-releases/1070311