Wheezing and Asthma in Young Children: What Every Parent Should Know Expert Insights from the Latest Scientific Guidelines

The information that follows is based on the large-scale systematic review “Preschool wheezing and asthma in children: a systematic review of guidelines and quality appraisal with the Agree II Instrument,” published in 2020 in the journal Pediatric Allergy and Immunology. The article is the result of the work of a multidisciplinary international team of leading experts in pediatric pulmonology, allergology, and pediatrics, united in the EAACI Task Force on Clinical Practice Recommendations on Preschool Wheeze. Among the authors are Dr. Marek Ruszczyński, Prof. Wojciech Feleszko, and other researchers and clinicians from Poland, Finland, Turkey, Greece, the United Kingdom, Germany, the Netherlands, and other European countries. This team systematized and analyzed the scientific recommendations and guidelines regarding the diagnosis and treatment of wheezing and asthma in early childhood, using the global AGREE II standard for quality assessment.

The following sections highlight five practically important questions and answers that directly address the needs and concerns of patients and their families dealing with this issue. These insights are selected solely based on the information provided in the cited study.

“Wheezing and shortness of breath in preschool children is a heterogeneous condition, and one of the most commonly presented symptoms in everyday pediatric practice.” (Ruszczyński et al., 2020)

Expert Insights

Wheezing and shortness of breath in early childhood are among the most common symptoms parents encounter in pediatric care. This condition is extremely heterogeneous—it varies depending on age, underlying causes, associated illnesses, and triggering factors. While some children outgrow these symptoms, in others they persist and develop into asthma. To support proper diagnosis and treatment, numerous national and international recommendations have been developed over the past 20 years, but their quality and applicability vary significantly. This is why the systematic review by the EAACI Task Force provides highly valuable information—for both medical professionals and patients with their families.

1. How common and significant are wheezing and asthma in young children?

“Wheezing and shortness of breath in preschool children is a heterogeneous condition, and one of the most commonly presented symptoms in everyday pediatric practice. A considerable minority of children will continue to experience wheezing in school years and beyond, diagnosed as ‘asthma’.”

Interpretation: The frequency of wheezing at this age is high, and some children are at risk of developing chronic asthma. This calls for careful attention from parents and monitoring by medical specialists.

2. Is there a universal definition of “preschool wheeze”?

“The term ‘preschool wheeze’ has not been appropriately defined, and it varies considerably between countries... our understanding of wheezing needs revision.”

Interpretation: Patients and their families should be aware that there is no universally accepted definition of this condition. Different countries and guidelines use varying age ranges and criteria, which makes it difficult to establish a clear diagnosis or compare data.

3. What are the main challenges in diagnosis and treatment?

“A thorough history and physical examination in wheezy preschoolers may help to identify children with a risk of asthma/atopy since it will guide the likelihood of symptoms persisting. In these patients, a treatment basing on the well-prepared guidelines can be applied, since many of them are good enough to instruct how to control clinical symptoms of wheezing.”

Interpretation: A key takeaway for parents is that diagnosis is not always straightforward and relies primarily on careful evaluation of symptoms, risk factors, and monitoring over time. Experts recommend an individualized approach rather than a “one-size-fits-all” solution.

4. What does the analysis of existing medical guidelines show?

“There is an abundance of guidelines targeting asthma in children, and their quality is rather good. However, the number of guidelines for preschool wheezing is lacking. Future guidelines for Preschool Wheezing should and will aim to identify EARLY individuals who are at risk for subsequent asthma inception and to provide them appropriate management and treatment.”

Interpretation: Although there are many asthma guidelines, few focus specifically on younger children and early wheezing. Therefore, it’s recommended to consult a specialist familiar with the most current and high-quality sources.

5. What direction should future medical guidelines take?

“We conclude that, even though there is an abundance of guidelines targeting asthma in children, the number of guidelines for preschool wheezing remains low. It seems essential that future guidelines for wheezy pre-schoolers would aim to identify individuals who may suffer from asthma in older age, in order to provide appropriate management and treatment.”

Interpretation: The direction is clear—there is a growing emphasis on personalized, precise diagnosis and timely treatment based on the child’s individual risk factors and needs.

Questions and Answers

1. What are the most common causes and triggers of wheezing in early childhood?

“Early life wheezing and repeated and cumulative lung injury due to viral respiratory infections (mainly rhinovirus or respiratory syncytial virus) may be causally associated with reduced lung function at six years of age, which might persist until adulthood.”

Answer: The most common triggers are viral respiratory infections, especially rhinovirus and RSV. Repeated infections like these can have a long-term impact on lung function.

2. Why is it so difficult to make an accurate diagnosis in young children?

“Since the diagnosis of asthma in preschoolers is difficult and depends on many factors, including persistence of symptoms of wheezing at the age of 6 years…”

Answer: Diagnosis is challenging because symptoms are often non-specific and can occur in other conditions. Not all children with wheezing will go on to develop asthma. Persistence of symptoms beyond age 6 is one of the key indicators.

3. Are all guidelines and recommendations equally useful for my case?

“There is an abundance of guidelines targeting asthma in children, and their quality is rather good. However, the number of guidelines for preschool wheezing is lacking… The quality scores for each domain varied. Of all domains, clarity and presentation had the highest mean score, whereas applicability and stakeholder involvement had the lowest.”

Answer: Not all recommendations are equally detailed or applicable specifically to children under 6. The best guidelines are clear but often don’t fully consider individual needs or the perspectives of families.

4. Have the recommendations improved over the years?

“Interestingly, the overall quality of the guidelines shows an improvement trend to improve over the last 20 years, even though it was statistically not significant.”

Answer: Over time, the guidelines have become better and more detailed, but there hasn’t yet been a revolutionary change guaranteeing ideal, personalized care for every patient. Still, the trend is encouraging for the future.

5. Are there common gaps or shortcomings in the guidelines that affect patients?

“The broad involvement of stakeholders, including patients’ groups (domain 2) as well as ease of guideline applicability with identification of possible costs and barriers (domain 5), were most troublesome and gained the lowest scores… Moreover, it should be emphasized that the recommendations rarely consider the views of the patient and the public.”

Answer: Many guidelines lack clarity about how to implement them in real-world settings and rarely take into account the needs and challenges of patients and their families. It is important for families to actively communicate with their healthcare providers to receive individualized care.

Conclusion

The analysis of the latest scientific guidelines and recommendations, conducted by the EAACI Task Force and summarized in the publication by Ruszczyński and colleagues, shows that while progress in the understanding and care of wheezing and asthma in preschool children has been substantial, significant challenges still remain for patients, families, and healthcare providers. The issue is complex and individualized, and international guidelines are increasingly encouraging a personalized approach, active communication with the medical team, and informed decision-making. The future of diagnosis and treatment is expected to become more child- and family-centered, with an emphasis on early risk identification and the application of high-quality, evidence-based practices.

Source Marek Ruszczyński et al. "Preschool wheezing and asthma in children: a systematic review of guidelines and quality appraisal with the Agree II Instrument." doi:10.1111/pai.13334