1013 Optimised phenotype management of recurrent preschool wheeze. (17th August 2022)

• Record Type: Journal Article
• Authors: Wilson, Kathryn; Magee, Rouchelle; Mullen, Caroline; Vasi, Veena
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A244
• Page End: A245
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.393
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Background: 3 out of 4 children presenting with wheeze are between 1-5 years of age. Most are due to transient viral wheeze. Only about 25% of these 'recurrent' wheezing children are atopic/inflammatory and go on to develop asthma. These group respond well to inhaled steroid treatment. In the rest, presenting with recurrent persistent wheeze, further investigations and treatment is necessary to prevent further attacks and morbidity. Objectives: Identify and manage preschool wheezers based on their phenotype. Reduce unnecessary steroid treatment and further admissions. Methods: 67 Children aged 1-5 years presenting to ED and children's ward for more than 2 times over the last 6 months were identified and followed up in Preschool Wheeze Outpatient Clinic. GP referrals were also included. They were assessed systematically to identify the wheezing phenotype-transient wheezers, atopic/inflammatory and non-atopic (infective or other significant underlying airway abnormality). Children who had inflammatory wheeze were identified by history and modified asthma predictive index. Some children who had persistent non-atopic wheeze had further investigations based on clinical assessment which included chest Xray, blood tests, throat swab, barium swallow etc. Parents were engaged throughout the assessment with ongoing education and management plan. We also had education and teaching sessions for paediatric trainees and ED staff to increase awareness of preschool phenotypes. Results: 22 of the 67 (33%) children were identified atopic and managed as asthma. 20 (30%) children had no further wheezing episodes and discharged with parent reassurance. 25 (37%) children were non-atopic who were investigated and treated for LRTI, allergic rhinitis with postnasal drip, GOR. A few were referred to Tertiary Paediatric Respiratory Service in RBHSC and subsequently got the diagnosis of tracheal bronchus, selective IgA deficiency, RUL bronchocele. 35% children had steroid inhalers stopped with no admissions or recurrence of sympto Conclusion: By optimising the management of preshool wheeze children based on phenotype, we reduced the children being treated unnecessarily with steroids by 35%. We also identified other underlying conditions for symptoms needing further investigations and management thereby reducing admissions and ongoing morbidity. Parental engagement led to reassurance and adherence to treatment.