In this review, researchers examine current thinking in regard to published recommendations for the management of preschool-aged children with recurrent wheezing, identifying gaps in our understanding and suggesting changes that may occur in the next 5 years. The Asthma Predictive Index, allergen-specific IgE, peripheral eosinophil count, and exhaled nitric oxide are potentially underused sources of information that might help predict asthma development and responsiveness to treatments. Inhaled corticosteroids and leukotriene receptor antagonists reduce impairment and exacerbation frequency in wheezing children, but do not change the illness. Macrolides may be beneficial in reducing the development of acute wheezing episodes to more severe symptoms. Studies with monoclonal antibodies targeting IgE and TH2 cytokines in adults and older children with asthma have been effective, but trials in younger children are needed.
Identifying the phenotypic and endotype of young wheezing children can aid in the prediction of future asthma risk and the selection of the most appropriate therapy. Primary asthma preventive measures are required during the key developmental window in childhood prior to the beginning of irreversible lung function decline.