The “Ten Commandments” of treating preschool children who wheeze

  • Robin J Green University of Pretoria
  • Andrew Halkas Krugersdorp Hospital
  • Eugene Weinberg University of Cape Town
Keywords: wheezing, pre-school, asthma


Wheezing in young children is problematic for most practitioners. Difficulties arise in both the diagnosis and management of this clinical phenotype. Not all preschool children who wheeze have asthma. Therefore, we suggest that the “Ten Commandments” of managing preschool wheezing include thinking that in very young infants (< 1 year) wheezing is likely to be viral in origin; realising that allergy testing is mandatory to diagnose the cause of early wheezing; taking a history of asthma and allergy in family members; noting that chronic coughing is a pointer to asthma; using the term “asthma” if that is the diagnosis; ensuring that the environmental avoidance of triggers is addressed; using a short course of montelukast for virus-induced wheezing episodes; avoiding steroids to treat virus-induced wheezing; treating associated nasal symptoms; and making sure that the follow-up of children addresses the issue of stopping therapy if it is not working.

Author Biographies

Robin J Green, University of Pretoria
PhD, FRCP Associate Professor Department of Paediatrics and Child Health University of Pretoria
Andrew Halkas, Krugersdorp Hospital
FC Paed(SA), MMed(Paed), FCCP) Children’s Chest and Allergy Clinic Krugersdorp Hospital
Eugene Weinberg, University of Cape Town
FCPaeds, FAAAAI Allergy Unit UCT Lung Institute
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