Personalising treatment for preschool children with recurrent wheezing to prevent attacks and reduce the long-term impact on their lung health

The Masonic Charitable Foundation Action Medical Research Training Fellowship* Dr K Hillson.

Up to half of all children aged between one and five years in the UK will experience wheeze – where they will make a high-pitched whistling sound when breathing.[1] Children who wheeze from a very young age, if not treated appropriately, will go on to develop asthma or reduced lung function – affecting their long-term quality of life. Dr Shalini Hillson of Imperial College London is investigating the feasibility of using bedside tests to identify the best treatment for each preschool child with recurrent wheezing. The long-term goal is to personalise treatment to help prevent wheezing attacks at this young age, which will reduce the lifelong impact on a child’s lung health.

This Research Training Fellowship is generously supported by The Masonic Charitable Foundation.

How are children’s lives affected now?

Wheezing is common in babies and young children and results from a narrowing of airways, making it harder to breathe. Three out of four children who are admitted into hospital with severe wheezing are under five years old – and approximately one in three young children who wheeze will develop asthma by school age.^2,3

“Wheezing noises can be distressing for both the child and their parents,” says Dr Hillson. “While many will outgrow their symptoms, one in three preschool children will go on to develop asthma or poorer lung function later in life – making them more susceptible to chronic respiratory diseases.” 

There are several different causes of wheezing in preschool children, such as lung infections or allergies. But current treatment methods assume all children have allergies and will respond similarly to inhaled steroids. This ‘one-size-fits-all’ approach means that many will experience no improvement in their symptoms.

How could this research help?

“Our ultimate goal is for preschool children with recurrent wheezing to routinely receive personalised treatment that will help prevent attacks,” says Dr Hillson.

The researchers have identified a set of bedside tests – including fingerprick blood tests, nose and throat swabs and a simple breathing test – that could be used to distinguish different types of wheezing and help match the right treatment to each child.

“This study will explore whether these tests are feasible, accurate, reproducible and acceptable to preschool children with recurrent wheeze and their families,” says Dr Hillson.

In a small group of patients, the researchers will also investigate whether basing treatment decisions on these test results provides better outcomes than the current approach.

“If these results are encouraging, the next step will be to apply these tests in a large clinical trial of targeted treatment for preschool wheezing – to find out whether it is possible to accurately identify the right treatment to prevent recurrent attacks and reduce the long-term impact on lung health,” says Dr Hillson.

References

1. Lowe LA et al. Wheeze phenotypes and lung function in preschool children. Am J Respir Crit Care Med 2005;171(3):231-7.
2. Davies G et al. Children admitted with acute wheeze/asthma during November 1998-2005: a national UK audit. Arch Dis Child. 2008;93(11):952-8. 
3. Bloom CI et al. Burden of preschool wheeze and progression to asthma in the UK: Population-based cohort 2007 to 2017. J Allergy Clin Immunol. 2021; 147(5):1949-1958.

*Research Training Fellowships: Each year, Action Medical Research awards these prestigious grants to help develop some of the UK’s brightest doctors and scientists as future leaders in children’s research.

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