A study into parents’ experiences of managing preschool wheeze identified problems with inconsistent terminology and uncertainty around diagnosis.
RT’s Three Key Takeaways
- Lack of Consistent Diagnosis and Management Guidelines: Parents reported frustration with inconsistent terminology and conflicting diagnoses for preschool wheeze, as well as the absence of clear diagnostic pathways or evidence-based management guidelines, which complicates care.
- Impact on Families and Healthcare Systems: Preschool wheeze significantly affects the quality of life for children and their families, leading to high levels of parental anxiety, work disruptions, and reliance on emergency healthcare services due to challenges accessing appropriate care.
- Call for Evidence-Based Policies and Investigations: Researchers emphasize the need for co-developed management policies and clinical trials to assess the efficacy of diagnostic tools, such as blood and allergy tests, which parents find acceptable if they improve timely and effective treatments.
A study led by Aston University’s Gemma Heath, PhD, and Prasad Nagakumar, MD, from Birmingham Children’s Hospital has shown that treatment and diagnosis for preschool wheeze needs more effective evidence-based guidelines.
Preschool wheeze is a condition affecting approximately 30–40% of children under age 6. The condition is characterized by episodes of wheezing or breathlessness, with younger children being particularly susceptible due to their narrower airways. Although it can resemble asthma, preschool wheeze is often triggered by viral infections or allergies and does not always mean a child will develop asthma.
The study is published in Archives of Disease in Childhood.
Preschool Wheeze: A Growing Health Concern in the UK
The UK has the second highest prevalence of preschool wheeze in 2-year-olds across Europe. It is a leading cause of emergency hospital visits and hospitalizations in the country. Repeated preschool wheeze attacks are frightening for parents, and result in significant morbidity, healthcare costs, and impaired quality of life for both the child and parent.
There is currently no diagnostic pathway or definitive management guidelines for preschool wheeze. The research team interviewed affected parents and carers about their experiences and found problems with diagnosis and treatment at multiple levels.
Inconsistent Terminology and Diagnostic Delays
The first major issue identified by parents was inconsistent terminologies used by doctors and confusing and conflicting diagnoses such as asthma, suspected asthma, viral wheeze, and allergy. Some reported frustration at the lack of definitive diagnosis, an apparent lack of general practitioner knowledge, sometimes false reassurance that the wheeze was viral rather than asthma, or that the cause was a “mystery.”
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A common problem was that investigative tests did not occur until after multiple hospitalizations. Blood tests for particular markers have the potential to identify whether asthma or an allergy is likely to have caused the wheeze, and therefore guide treatment. The parents in the study welcomed the idea of timely tests but stressed that children should not be subjected to repeated testing.
Preschool wheeze is generally managed with steroid and salbutamol inhalers, as for asthma. While parents had concerns about the side effects and long-term impacts of using the treatments, they deemed the medication “an acceptable cost.”
Emotional and Practical Impacts on Families
Parents reported being “terrified” while watching attacks of preschool wheeze and significant psychological impacts when their child was admitted to the hospital. Some had missed work or even given up work to care for their child, with high levels of anxiety, while others said they felt unable to go on holiday overseas due to concerns about healthcare access in the case of a wheeze attack.
Most parents preferred to access care at a hospital rather than at doctors’ surgeries due to the perception of a lack of training for general practitioners and a lack of confidence. However, accessing necessary care can be difficult, including due to childcare difficulties, the cost of hospital parking, and a lack of available ambulances.
Call for Evidence-Based Policies and Future Research
The research team says that parents’ views highlight the problems and called for clinical trials to determine the efficacy of treatment decisions made according to the results of investigations.
“This research demonstrates an urgent need for preschool wheeze management policies and treatment pathways that are evidence-based and co-developed with parents. We have shown that use of investigations such as blood or allergy tests would be acceptable to parents, if they were shown to be helpful in guiding more effective and timely treatments,” Heath says in a release.
Nagakumar adds in a release, “Preschool wheeze has significant impact on young children’s and their parents’ lives. Our research, involving parents with lived experience, will inform future studies to improve the care and reduce the impact of preschool wheeze on the already-stretched emergency health services in the UK.”