How do we measure success of treatment?
Patient reported outcomes (PROMs) highlight what is important to the patient (“can I get upstairs?”) rather than what is conventionally measured by physicians, e.g. changes in spirometry, and are increasingly used in clinical practice and research [58] . They need to be co-designed with families. Unfortunately, currently none such exist for preschool wheeze. Disease control can be assessed by the Test for Respiratory and Asthma control [59] and the Paediatric Asthma Quality of life questionnaire in children age over 2 years. There are versions designed for parentsto answer [60, 61], and instruments assessing the severity of attacks and parental feelings during the episode[62, 63]. Developing PROMs for pre-school wheeze is an important research priority.