What we know: The different
wheezing phenotypes in early childhood may influence the response to
therapy. beta-Agonists are effective in acute
asthma from the first year of life and
anticholinergics have been shown to provide additional benefit from at least 18 months of age. Non-steroidal preventer medications provide some benefit in early childhood
asthma, but response is variable and dependent on severity. Inhaled
corticosteroids are the most effective preventer medication in children with persistent
asthma, but have not been shown to be effective in children with episodic viral wheeze. There is no convincing evidence to suggest that inhaled
corticosteroids influence long-term outcome in childhood
asthma. What we need to know: Can we distinguish different
wheezing phenotypes at presentation (using clinical features or other markers of airway
inflammation or
airway hyperresponsiveness) in order to target
therapy? What are the relative benefits of reliever and preventer medications in treating different
wheezing phenotypes, and do all
wheezing phenotypes require treatment? What is the dose-response curve for inhaled
corticosteroids in infants and young children with
asthma? Are infants and young children more susceptible than older children to growth suppression or other side effects from inhaled
corticosteroids? Can early treatment with inhaled
corticosteroids or non-steroidal medications influence long-term outcome in terms of
asthma development and/or loss of lung function?