Experts establish standardized protocols for diagnosing frequent wheezing in children

Frequent wheezing, a respiratory disorder caused by narrowing of the airways, mainly affects children under 5 years of age. The multifactorial causes of frequent wheezing pose a challenge to its diagnosis and treatment. As a result, standardized evidence-based clinical guidelines are not available to pediatricians to manage frequent wheezing in infants and children.

To fill this knowledge gap, the Pediatric Committee of the China Medical Education Association convened a group of experts, including pediatric respiratory medicine and allergology, to recommend standardized guidelines for the management of frequent wheezing in infants and children. These guidelines have been published in the journal pediatric checkup On 5 March 2026.

Led by leading pediatric respiratory medicine experts Professor Kunling Shen of the National Center for Children’s Health, Beijing, and Professor Yunxiao Shang of Shengjing Hospital, China Medical University, China, the guidelines aim to provide physicians with standardized protocols to increase diagnostic accuracy and therapeutic efficacy in the management of pediatric patients with frequent wheezing.

Explaining the rationale for developing these guidelines, Prof. Shane commented, “Evidence-based guidelines are important to effectively manage diseases, especially those with multifactorial etiologies, such as frequent wheezing. “Establishing guidelines may assist pediatricians to implement therapeutic and preventive strategies uniformly and consequently improve the clinical outcomes of patients.”

As a first step toward developing the guidelines, two important definitions were established. Recurrent wheezing was defined as three or more wheezing episodes, each episode separated by a 7-day asymptomatic interval. Meanwhile, infants and children were defined as those between 29 days and 3 years of age. Subsequently, definitions were provided to classify recurrent wheezing, taking into account the expression of symptoms (episodic viral wheezing, multiple trigger wheezing, and unclassified wheezing) and immunological responses (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).

The expert panel recommended various guidelines for the diagnosis of frequent wheezing. Clinical history recording and physical examination are the major initial procedures for diagnosis. Laboratory testing (such as eosinophil count and allergen testing), chest imaging, pulmonary function testing, and fractional exhaled nitric oxide analysis were strongly recommended for clinical investigation. The most common cause of frequent wheezing in infants and children is viral infection. Guidelines also recommend testing for common respiratory pathogens, such as respiratory syncytial virus, rhinovirus, and human metapneumovirus. In addition to viral pathogens, the guidelines emphasize the need to test for infections caused by bacteria such as Streptococcus pneumoniae and the like. Haemophilus influenzae. Other recommended ancillary tests to diagnose frequent wheezing include esophageal pH testing, bronchoscopy, swallow 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 proposed guidelines, the management of recurrent wheezing is based on the principle of “assessment-diagnosis-treatment-re-evaluation-rediagnosis”. Recommendations for the use of immunomodulators, vitamin D, probiotics, LTRAs, and antihistamines as prophylactic agents are weak in the guidelines. To predict the prognosis of recurrent asthma, asthma prediction tools and long-term pulmonary function assessment are strongly recommended. Pro. Shang explains the application of these guidelines, “The lack of standard guidelines for the management of frequent wheezing in infants and children has resulted in inconsistent implementation of therapeutic and preventive strategies, leading to poor quality of life. The guidelines we developed may provide a framework for improving the management of frequent wheezing in infants and children worldwide.”