الفهرس 
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Abstract
Prevalence of recurrent wheeze in the preschool age was reported to affect one third of children in the developed world, with even more frequency and severity in the developing countries. Epidemiological studies on this subject in Egypt are lacking.
This cross-sectional study was designed to investigate the frequency, triggers, risk factors and severity of preschool wheezes (PSW) among a group of Egyptian children. Children were recruited to participate in the study during their visits to the emergency department (ED) of Suez General Hospital in the period from May 2019 to April 2020. The investigator has interviewed 3720 children, aged between 1 and 5 years, along the duration of the study. Patients with known congenital or chronic lung diseases, congenital heart diseases, suspected or confirmed inborn errors of immunity, chronic infections like tuberculosis, gastrointestinal reflux disease, persistent vomiting, faltering growth, malabsorption or inflammatory bowel disease and patients with suspected FB aspiration were excluded.
Children presenting with wheezes were asked about their sociodemographic data, family history of allergy, previous wheezes episodes, possible risk factors, environmental exposures, previous hospital admission due to PSW and if they were on controller therapy. Physical examination was done to confirm the presence of wheeze, assess the severity, ensure the inclusion and exclusion criteria and associated allergic manifestations. Complete blood count (CBC) was investigated for children younger than 3 years who experienced previous 4 wheeze flare ups or more.
Out of 3720 infants and children aged between 1 to 5 years, 302 (8.1%) patients had PSW, with mean age of 2.65 ± 1.21, being 187(61.9%) males and 115 (38.1%) females. Patients who lived in urban areas were 242 (80.1%), and those who lived in rural areas were 60 (19.9%). More frequent episodes of PSW were noticed at November (43, 14.2%), followed by January (39, 12.9%), February (36, 11.9%), then March and December (31, 10.3% each). According to seasons, winter and fall had the highest frequency of PSW (106, 35% and 104, 34.5% respectively).
Indoor exposures were as follows: 144/302 (47.7%) were exposed to parental smoking, 50/302 (16.6%) exposed to pets, animals or birds, and 35/302 (11.6%) exposed to fumes, whereas 23/302 (7.6%) exposed to farms. Associated allergies were found in 189/302 (62.7%) of the studied patients, distributed as follows: 32.8% had rhinitis, 14.6% had urticaria and/or angioedema, 12.3% had eczema, and 2.3% had anaphylaxis and 0.7% with gastrointestinal (GIT) manifestations.
For 25/302 patients (8.3%), it was the first episode of PSW, whereas the other 277/302 (91.7%) had experienced previous episodes of wheezes. Out of the latter 277 patients, 180 (59.6%) had history suggestive of episodic viral wheeze, and 97 (32.1%) had history suggestive of multiple trigger wheeze. According to classification of wheezes severity, 37.5% had intermittent, 35.3% had mild persistent, 23.4% had moderate, and 3.6% had severe PSW. Nearly half of the patients (47.3%) were well controlled, 14% were uncontrolled and 38.9% were partially controlled. Previous hospital admission due to PSW was needed in 47% of patients, 7% of them were admitted to pediatric intensive care unit.
Based on GINA stepwise approach for management of PSW, 80.8% of patients were in step 1, 9.3% were in step 2, 8.6% were in step 3, and 1.3% were in step 4. Absolute eosinophilic count (AEC) in children aged less than 3 years old who experienced more than 4 episodes of wheezes (101 patients) was 0.5 x 106 with range 0.04-1.2 x 106. Modified asthma predictive index was then calculated and was positive in 50.1% of the children younger than 3 years with PSW.