Abstract
Introduction: Preschool wheeze is a public health issue, due to its high
frequency and morbidity. When the disease is severe and uncontrolled,
despite optimal treatment, explorations are needed. Patients and
methods: We conducted a retrospective study at our tertiary asthma
center in Rouen University Hospital, France. Each child under 3 years
with severe uncontrolled preschool wheeze was admitted to a pediatric
day hospital for a bronchoscopy. We collected the results of clinical,
biological and radiological exams, and followed-up data at 1, 2 and 3
years (Y +1, Y +2, Y +3
respectively), to study the evolution of the disease, and identify
factors of uncontrolled disease. Results: We included 135 patients; 63
(47%) were still followed-up in our center at Y +3.
Median age at inclusion was 12 months. Thirty percent of patients still
had severe uncontrolled wheeze at Y +3. Treatments were
significantly decreased at Y +3 (p<0.001). A
total IgE level higher than 7 kU/L was a factor in uncontrolled wheeze
at Y +1, tobacco exposure (p<0.001) and female
gender (p=0.05) were factors associated to the persistence of
uncontrolled wheeze at Y +2, and a first case of
bronchiolitis before 2 months old was a factor in uncontrolled disease
at Y +3 (p=0.007). Discussion: Our study is unique in
terms of its very young population, with very severe wheeze (80% of
children included with a history of hospitalization, 8% in intensive
care). Our therapeutic approach is original, enabling us to study the
evolution of “therapeutic pressure” in the early years of this
frequent disease, the pathophysiology of which is still poorly
understood.