Coughs and wheezes spread diseases: but what about the environment?

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Abstract
One disagreeable part of growing up is the inevitable encounters with respiratory viruses which, in about half the population, will have led to at least one wheezing episode before school age. For many the symptoms of wheeze are trivial and require no or only intermittent treatment but, for others, winter in particular turns into a nightmare of recurrent hospital admissions punctuated by brief periods of perfect health before the next viral infection takes hold. All concerned feel powerless in both prevention and treatment; for many families it is inevitable that they use childcare facilities, a fertile virological breeding ground. In any case, the possible protective effects of viral infections against later asthma (below) should give pause for thought before removing the child from the crèche. Although there is some evidence that intermittent high dose inhaled corticosteroids1 or oral montelukast2– 4 may be adequate treatment, many children with viral associated wheeze end up being prescribed several courses of oral prednisolone each winter. The treatment of severe preschool viral induced symptoms is among the most taxing and least rewarding challenges in childhood wheezing disorders.