Management of recurrent preschool wheeze (PICTURE)v1
Research type
Research Study
Full title
Prospective Observational Cohort Study of Management of Preschool children with Recurrent Wheeze (PICTURE STUDY)
IRAS ID
322156
Contact name
Prasad Nagakumar
Contact email
Sponsor organisation
Birmingham Women's and Children's Hospital NHS Trust
Duration of Study in the UK
2 years, 5 months, 10 days
Research summary
Preschool wheeze (PSW) is common. Approximately 30-40% of all children will experience recurrent wheeze attacks in the first 6 years of life. Seventy five percent of all children with wheeze admitted to hospital are aged between 1-5 years and UK has the second highest prevalence of wheeze during the second year of life in Europe. PSW results in significant morbidity, healthcare costs, and impaired quality of life for the child and parents. Preschool wheezers account for a third of all healthcare costs for childhood asthma. Recurrent wheeze attacks predict long term diminished lung function and increase all cause morbidity and mortality in early adulthood. Current treatment of PSW is based on expert consensus with little evidence. Medications prescribed in PSW are those used in school age children and adults with asthma. The recommendations by the British Thoracic Society and the European Respiratory Society are based on parent or child reported symptoms.Inhaled steroids,albutamol, Montelukast are some of the medications recommended to prevent wheeze attacks. PSW is clinically classified phenotypically as children who wheeze only with colds (episodic wheeze), and multi trigger wheeze in which the child also wheezes in between episodes of colds, usually with activity. The clinical phenotypes overlap and rely on accurate parental reporting of symptoms. The respiratory viruses commonly trigger wheeze attacks and therefore, the wheeze attacks in preschool children are more common in winter and spring months. Recent evidence favors treating PSW with daily inhaled steroids based on the results of blood eosinophil count and allergy tests.
However, blood tests/allergy tests are not routinely performed in primary care and children are referred to hospital for investigations. In hospitals, the availability of personnel to perform these tests routinely in young children in an outpatient setting is also variable. The perception of health professionals and parents in performing these tests routinely is not known. Moreover, the adherence to inhaled steroids even in those with recurrent severe PSW is just 30% and therefore understanding parents’ perceptions of benefits of medications prescribed, especially inhaled steroids, is vital.
Prior to undertaking an interventional trial to assess the efficacy of test-guided management, a prospective observational study is required to determine current clinical practice in the management of children with recurrent PSW and the barriers to performing such tests.
Emerging research indicates potential for the use of biomarkers, including blood eosinophil counts and allergy tests to predict response to inhaled steroids in children with PSW. While the introduction of routine blood/allergy tests for children with PSW may present opportunities for targeted management, acceptability of this approach, from the perspectives of parents and health professionals is not known.
However, blood tests/allergy tests are not routinely performed in primary care and children are referred to hospital for investigations. In acute hospitals, the availability of personnel to perform these tests routinely in young children in an outpatient setting is also variable. Moreover, the perception of health professionals and parents to performing these tests routinely is not known.
Understanding the perceptions of parents and professionals, including barriers to uptake of blood/allergy testing, is an essential first step for determining feasibility of treating preschool wheeze based on objective, biomarker tests. Identification of such barriers could support the development of resources for parents and professionals to overcome these barriers. It is also possible that use of biomarkers to specify appropriate steroid treatments will impact on parental administration/adherence to treatment guidelines, where current adherence to treatment is even in those with severe recurrent wheeze attacks is only 30% (Saglani et al 2022).
In order to explore the views of parents and health professionals on using biomarkers (blood/allergy tests) to guide personalized treatment plans for the management of preschool children with recurrent wheeze, a qualitative study is needed to determine parental and professional acceptability of routine blood/allergy tests to guide inhaled steroid use in children with PSW.REC name
Wales REC 4
REC reference
23/WA/0109
Date of REC Opinion
23 Mar 2023
REC opinion
Favourable Opinion