INTERVIEWS with UK clinicians found inconsistent terminology and testing gaps that drive variation in preschool wheeze management.
Challenges in Preschool Wheeze Management
Health professionals report that preschool wheeze remains a significant clinical problem, yet one that is managed inconsistently across services. In this qualitative study, researchers recruited clinicians with experience managing children with preschool wheeze from primary and secondary care settings across England, using purposive and snowball sampling. Semi structured interviews were conducted via Microsoft Teams, then transcribed and analyzed thematically with NVivo to identify common barriers and priorities.
Fourteen health professionals participated, including general practitioners, general pediatricians, hospital asthma nurses, and both primary care and tertiary respiratory pediatric clinicians. Across roles, participants described the day to day reality of managing recurrent symptoms in young children with limited objective tools, and they emphasized how this uncertainty can influence decisions about investigation and treatment.
Preschool Wheeze Management and Diagnostic Uncertainty
A central theme was inconsistent diagnostic terminology. Clinicians viewed variable language as more than a documentation issue, since it can affect communication across teams and shape how families understand the condition and its likely trajectory. Participants also highlighted diagnostic uncertainty linked to the absence of objective tests to support early asthma diagnosis in preschool children. This uncertainty was described as contributing to variation in management plans, particularly when clinicians must decide whether and how to trial therapies over time.
Infrastructure, Testing, and Integrated Care Pathways
Clinicians described a lack of infrastructure and a limited, consistent approach to performing tests in both primary and secondary care. In practice, this can make it difficult to use investigations to guide treatment for children with recurrent wheeze, even when clinicians believe testing could be helpful. The study also noted differences between primary and secondary care perspectives, suggesting that expectations and available resources may not be well aligned across settings.
Overall, the findings support the need for integrated care pathways and improved infrastructure to reduce variation and improve outcomes in preschool wheeze management.
Reference: Abdul Wajid LM et al. Exploring health professional views of management for preschool wheeze: a qualitative study. Arch Dis Child. 2025;doi:10.1136/archdischild-2025-329350.
