ABSTRACT
Two constant themes have recurred throughout this book. On the one hand, we have outlined the importance of events occurring during the first years of life as predictors and harbingers of the subsequent development of chronic respiratory symptoms and chronic obstructive disease later in life. On the other hand, we have stressed the lack of real, hard facts about the etiology and pathophysiology of the disease process occurring in the typical wheezy infant and preschool child, and the optimum approach to diagnosis and management. It is very difficult to explain why a condition that seems to be such an important risk factor for the development for subsequent chronic illnesses and that, at the same time, has such a strong impact in terms of morbidity during the first years of life has not, until recently, become the focus of interest of significant research and attention by the academic and business communities. It could be argued that there are significant limitations to our capacity to study any condition in infants and very young children. Regulatory institutions may also have contributed to making some of the most frequent illnesses affecting young children almost comparable (in terms of research interest) to the so-called ‘orphan diseases’, which are several orders of magnitude rarer and have only a tiny fraction of the impact that wheezing has on public health. Indeed, in most countries, regulatory agencies do not require that medicines that have been shown to be effective in the treatment of conditions that are clinically similar to early childhood wheezing are specifically tested in this age group. This has resulted in the bewildering situation described in Chapter 7 dealing with treatment of wheezing: most pediatricians and caregivers who treat children with wheezing know that medicines used to treat asthma in adults are much less effective in this age group, but are constrained to continue using them simply because there are few drugs that have been tested specifically in infants and young children. As physicians who have dedicated a significant part of our lives to the study, prevention and treatment of wheezing disorders in young children, we believe this situation is unacceptable and needs to be remedied.
