Research Article: A Disease Model for Wheezing Disorders in Preschool Children Based on Clinicians’ Perceptions

Date Published: December 31, 2009

Publisher: Public Library of Science

Author(s): Ben D. Spycher, Michael Silverman, Juerg Barben, Ernst Eber, Stéphane Guinand, Mark L. Levy, Caroline Pao, Willem M. van Aalderen, Onno C. P. van Schayck, Claudia E. Kuehni, Dominik Hartl.

Abstract: Wheezing disorders in childhood vary widely in clinical presentation and disease course. During the last years, several ways to classify wheezing children into different disease phenotypes have been proposed and are increasingly used for clinical guidance, but validation of these hypothetical entities is difficult.

Partial Text: Wheezing disorders in childhood are common and vary widely in clinical presentation and disease course (onset, remission and relapse). Within this syndrome, various phenotypes have been proposed, classified either by triggers of wheeze, into “episodic viral wheeze” triggered only by colds and “multiple-trigger wheeze” triggered also by other factors [1], [2], [3], or by time course into “early transient”, “persistent” and “late-onset” wheeze [4], [5]. Such phenotypes are being used in the study of risk factors [4], [6], [7], [8], [9], prognosis [10], [11], [12], [13] and response to treatment [2], [14], [15], and also increasingly in treatment recommendations and guidelines [2], [16], [17]. However it is unclear whether they represent distinct disease entities with separate aetiologies or rather different facets of the same disease. Because the underlying disease mechanisms are poorly understood it is difficult to define a biologically plausible classification of wheezing disorders.

In this study we aimed to agree on a disease model for wheezing disorders in young children consisting of distinct disease entities each based on plausible mechanisms. We wanted this model to be developed and agreed upon by clinicians who encounter the full range of clinical presentations of these disorders, working in primary, secondary, and tertiary care. The model is the first step in a validation study of statistical methods used to identify subgroups of disease from epidemiological data.



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