In recent years the understanding about the mechanism of development of wheezing in children has improved and various management strategies were tried by different researchers. The respiratory syncytial virus induced bronchiolitis and rhinovirus infection in preschool children may lead to recurrent wheezing in preschool children. In infant immune system is immature and depends mainly on TLR ligation and maternal derived antibodies. Anti-inflammatory cytokines such as IL-10 and TGF beta are more common. RSV NS1 and NS2 proteins target RLR and TLR 3 dependent signaling and suppress the cellular response to RSV replication .This can lead to Th2 like response leading to asthma and allergy. CDHR3 acts as receptor in rhinovirus C infection. RV infection causes increase in IL 25 and IL 33 both induce Th2 type of immunity by increasing IL5 and IL 13. Daily Inhaled Corticosteroids (ICS) have been found useful in preventing exacerbations. Evidence is inconclusive about intermittent inhaled corticosteroids, intermittent montelukast and daily montelukast in recurrent wheezing. Azithromycin started early may decrease duration of wheezing episode. About intravenous magnesium sulfate and hypertonic saline evidence is inconclusive. Vitamin D supplementation in preterm babies for 6 months and avoidance of cow’s milk for first three days of life may be useful in prevention of recurrent wheezing in preschool children.
Dr. Suhas P. Kulkarni has done MD (Pediatrics) and fellowship in allergy and clinical Immunology. He is working as Associate professor in department of pediatrics, D.Y.Patil Medical College, Kolhapur, MH, India. He is about to complete his Ph D in pediatrics (Pulmonology). He has 14 research papers to his credit. His topic of interests are pulmonary function testing in children especially impulse oscillometry system. He is a PG guide and examiner to MD Pediatrics. He is also interested in medical education technology and simulation.