Abstract 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 may be
divided into episodic viral and multiple trigger to guide treatment, but
the pattern of symptoms must be re-assessed regularly. However, symptom
patterns are a poor guide to underlying pathology. 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, including new data on the place of leukotriene receptor
antagonists, prednisolone for acute attacks of wheeze and antibiotics,
based on new attempts to understand the underlying pathology in a way
that is clinically practical.
Keywords: Atopy, prednisolone, leukotriene receptor antagonist,
azithromycin, tiotropium