The therapy of pre‐school wheeze: Appropriate and fair?

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Abstract
The current study aimed to assess prevalence and distribution of use of asthma medication for wheeze in pre‐school children in the community. We sent a postal questionnaire to the parents of a random population‐based sample of 4,277 UK children aged 1–5 years; 3,410 participated (children of south Asian decent were deliberately over‐represented). During the previous 12 months, 18% of the children were reported to have received bronchodilators, 8% inhaled corticosteroids (ICS) and 3% oral corticosteroids. Among current wheezers these proportions were 55%, 25%, and 12%, respectively. Use of ICS increased with reported severity of wheeze, but did not reach 60% even in the most severe category. In contrast, 42% of children receiving ICS reported no or very infrequent recent wheeze. Among children with the episodic viral wheeze phenotype, 17% received ICS compared with 40% among multiple‐trigger wheezers. Use of ICS by current wheezers was less common in children of South Asian ethnicity and in girls. Although a high proportion of pre‐school children in the community used asthma inhalers, treatment seemed to be insufficiently adjusted to severity or phenotype of wheeze, with relative under‐treatment of severe wheeze with ICS, especially in girls and South Asian children, but apparent over‐treatment of mild and episodic viral wheeze and chronic cough. Pediatr Pulmonol.