Since the publication of the European Respiratory Society (ERS) task force reports on the management of preschool wheezing in 2008 and 2014, a large body of evidence has accumulated suggesting that the clinical phenotypes that were proposed (episodic (viral) wheezing and multiple-trigger wheezing) do not relate to underlying airway pathology and may not help determine response to treatment. Specifically, using clinical phenotypes alone may no longer be appropriate, and new approaches that can be used to inform clinical care are needed for future research. This ERS task force reviewed the literature published after 2008 related to preschool wheezing and has suggested that the criteria used to define wheezing disorders in preschool children should include age of diagnosis (0 to <6 years), confirmation of wheezing on at least one occasion, and more than one episode of wheezing ever. Furthermore, diagnosis and management may be improved by identifying treatable traits, including inflammatory biomarkers (blood eosinophils, aeroallergen sensitisation) associated with type-2 immunity and differential response to inhaled corticosteroids, lung function parameters and airway infection. However, more comprehensive use of biomarkers/treatable traits in predicting the response to treatment requires prospective validation. There is evidence that specific genetic traits may help guide management, but these must be adequately tested. In addition, the task force identified an absence of caregiver-reported outcomes, caregiver/self-management options and features that should prompt specialist referral for this age group. Priorities for future research include a focus on identifying 1) mechanisms driving preschool wheezing; 2) biomarkers of treatable traits and efficacy of interventions in those without allergic sensitisation/eosinophilia; 3) the need to include both objective outcomes and caregiver-reported outcomes in clinical trials; 4) the need for a suitable action plan for children with preschool wheezing; and 5) a definition of severe/difficult-to-treat preschool wheezing.

自欧洲呼吸学会 (ERS) 工作组于 2008 年和 2014 年发表关于学龄前喘息管理的报告以来，已经积累了大量证据，表明所提出的临床表型（阵发性（病毒）喘息和多重触发）喘息）与潜在的气道病理无关，可能无助于确定对治疗的反应。具体来说，单独使用临床表型可能不再合适，未来的研究需要可用于指导临床护理的新方法。该 ERS ​​工作组回顾了 2008 年之后发表的与学龄前喘息相关的文献，并建议用于定义学龄前儿童喘息疾病的标准应包括诊断年龄（0 至 <6 岁）、至少一次确认喘息、以及不止一次的喘息症状。此外，可以通过识别可治疗的特征来改善诊断和管理，包括与2型免疫相关的炎症生物标志物（血液嗜酸性粒细胞、空气过敏原致敏）以及对吸入皮质类固醇的差异反应、肺功能参数和气道感染。然而，更全面地使用生物标志物/可治疗特征来预测治疗反应需要前瞻性验证。有证据表明特定的遗传特征可能有助于指导管理，但必须对这些特征进行充分的测试。此外，工作组还发现，缺乏护理人员报告的结果、护理人员/自我管理选项和特征，应促使该年龄段的专家转诊。 未来研究的重点包括重点确定：1）导致学前喘息的机制； 2）可治疗特征的生物标志物以及对无过敏性过敏/嗜酸性粒细胞增多症的干预措施的有效性； 3）需要在临床试验中纳入客观结果和护理人员报告的结果； 4）需要针对学龄前喘息儿童制定合适的行动计划； 5) 严重/难以治疗的学前喘息的定义。