nephrotic syndrome in a neonate . Spontaneous resolution of congenital

Wheezy bronchitis was originally used to describe preschool children who wheezed only after viral respiratory tract infections and who seemed relatively resistant to sympathomimetic and steroid treatment. It was thought that only a minority of these children went on to develop 'asthma'. With the increasing awareness of the underdiagnosis of asthma in childhood the term was re-examined.2 Wheezy bronchitis was attacked as an over used euphemism for childhood wheeze. Far from avoiding the diagnosis 'asthma', implying a chronic illness, the use of 'wheezy bronchitis' led to undertreatment and inappropriate use of antibiotics in many true asthmatics. It was suggested that all who wheezed should be lumped together as asthmatic unless proved otherwise. In keeping with this concept most doctors and many parents now perceive asthma as a common condition with a wide range of severity and symptoms throughout childhood. Last year Dr Nicola Wilson re-examined the idea of splitting up wheezy disorders in childhood.3 Like Professor Margaret TurnerWarwick, who described different patterns of airflow obstruction in chronic adult asthmatics,4 she has argued that difficulties in treating asthmatic preschool children related to a failure in identifying clinical subgroups with different patterns of illness. Lacking a better term, she described a splinter group of 'wheezy bronchitics' as children who wheezed only in response to viral infections with little or no atopy compared with asthmatics of the same age. If the term is to be used at all it should refer to these kind of children. This is clearly not the group of patients studied in Finland. Forty three percent of these were highly atopic and atopic features were common in the rest. We are given no information about a family history of atopy. Although viral infections were identified in 45% of respiratory episodes, wheezing occurred in 73% of respiratory episodes in which no virus was found. These children might have had typical asthma with wheeze secondary to precipitants unrelated to viral infections. Thirty nine percent of children were receiving regular prophylaxis. This might have prevented persistent asthma symptoms that would otherwise have been present. If childhood asthma is to be split up careful attention must be paid to clearly defining separate subgroups. This is particularly important when considering pathogenesis and treatment of airway narrowing in our young wheezers.