Recurrent wheezing is a respiratory disease caused by narrowing of the airways and primarily affects children under the age of five. The causes of recurrent wheezing are multifactorial, creating challenges in diagnosis and treatment. As a result, standardized evidence-based clinical guidelines are not available for pediatricians to manage recurrent wheezing in infants and young children.
To fill this knowledge gap, the Chinese Medical Education Association Pediatrics Committee convened an expert group that included experts in pediatric respiratory medicine and allergy and recommended standardized guidelines for the management of recurrent wheeze in infants and young children. These guidelines are published in the magazine pediatric survey March 5, 2026.
Led by Professor Kunlin Shen, a leading expert in pediatric respiratory medicine at the National Children’s Health Center in Beijing, and Professor Yunxiao Xiang from Shengjing Hospital of China Medical University, the guidelines aim to provide clinicians with standardized protocols to improve diagnostic accuracy and treatment efficacy in the management of pediatric patients with recurrent wheezing.
Explaining the rationale for developing these guidelines, Professor Shen said:Evidence-based guidelines are important for the effective management of diseases, especially those with multifactorial etiology, such as recurrent wheezing. The establishment of guidelines will help pediatricians uniformly implement treatment and prevention strategies, thereby improving clinical outcomes for patients. ”
As a first step in developing the guidelines, two important definitions were established. Recurrent wheezing was defined as three or more episodes of wheezing, with each episode separated by an asymptomatic interval of 7 days. Infants and young children, on the other hand, are defined as those from 29 days old to 3 years old. Next, definitions were provided to classify recurrent wheezing. This is based on the onset of symptoms (transient viral wheezing, multiple-triggered wheezing, and unclassified wheezing) and immunological response (allergic wheezing and non-allergic wheezing), age of onset (transient early wheezing, early-onset persistent wheezing, and late-onset wheezing), and severity (mild wheezing and severe wheezing). wheezing).
An expert panel recommended different guidelines for diagnosing recurrent wheezing. Taking a clinical history and physical examination are important initial processes in diagnosis. Laboratory tests (e.g., eosinophil count and allergen tests), chest imaging, pulmonary function tests, and fractional exhaled nitric oxide analysis were strongly recommended as diagnostic tests. The most common cause of recurrent wheezing in infants and young children is a viral infection. The guidelines also recommend testing for common respiratory pathogens such as respiratory syncytial virus, rhinovirus, and human metapneumovirus. The guidelines emphasize the need to test for bacterial infections, such as pneumococci and pneumococci, in addition to viral pathogens. Haemophilus influenzae. Other ancillary tests recommended to diagnose recurrent wheezing include esophageal pH testing, bronchoscopy, swallowing function assessment, and genetic testing.
Management of recurrent wheezing can also be improved through type 2 inflammatory disease testing, environmental assessment, nutritional assessment, and establishment of a long-term follow-up plan. According to the draft guidelines, the management of recurrent wheeze is based on the principle of “assessment-diagnosis-treatment-re-evaluation-re-diagnosis.” Recommendations regarding the use of immunomodulators, vitamin D, probiotics, LTRAs, and antihistamines as prophylactic agents are inadequate in guidelines. Asthma prediction tools and long-term lung function assessments are highly recommended to predict the prognosis of recurrent asthma. Professor Xiang explains the application of these guidelines:The lack of standard guidelines for managing recurrent wheeze in infants and young children has led to inconsistent implementation of treatment and prevention strategies, leading to decreased quality of life. The guidelines we have developed can provide a framework to improve the management of recurrent wheeze in infants and young children worldwide. ”
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Reference magazines:
Pediatrics Committee. others. (2026) Evidence-based guidelines for clinical practice in the diagnosis, treatment, management, and prevention of recurrent wheeze in infants and young children in China. pediatric survey. DOI: 10.1002/ped4.70046. https://onlinelibrary.wiley.com/doi/10.1002/ped4.70046
