Projection of Children Diseases into Adulthood: If Wheezing Stop it Means no Asthma?

Wheezing is a major medical and social problem affecting up to 50% of children under the age of 6 years. Asthma diagnosis in early childhood is challenging not only due to symptoms recognition, but current clinical tactics of paediatricians to postpone asthma diagnosis in children of first 3 years of age as well. The fundamentals to postpone diagnosis is based on disappearance of wheezing symptoms in majority of children before school age and the attempt to explain course of the disease using adult asthma model. ERS proposed a definition of wheezing phenotypes based on the patterns of symptom presentation, namely the episodic viral wheeze (EVW) and multiple-trigger wheeze (MTW). The most recent studies found only a small fraction of both phenotypes to be stable over a 2-year period. Although the odds for developing asthma were greater in those with stable MTW some children with EVW also developed “chronic” asthma. On the other hand, transient early wheeze is associated with chronic obstructive pulmonary disease (COPD) genes. Longitudinal cohort studies allowed distinguishing up to 7 phenotypes of wheezing, but this complex phenotyping is unused in daily practice. Current data need to be unified, simplified, and a prognosis based phenotyping of wheezing syndrome is to be developed.

Two major clinical asthma phenotypes are proposed: the 1^st or “children’s phenotype” that is characterized by early onset and most likely transient course (symptom-free by school age, but high risk for COPD in adulthood), not associated with atopy nor familial history of asthma, and the 2^nd or “adults’ phenotype” which is characterized by later onset wheezing usually beyond the age of 3 years, most likely persistent symptoms into adult age, and associated with atopy and/or asthma in close relatives. Further research is needed for better translation of wheezing phenotypes into clinical practice.