Chronic respiratory conditions are major causes of morbidity and mortality in childhood. Such children may have impaired physical, emotional, and general well-being. Their illness and associated stressors can have a great impact on their caregivers, especially when recurrent hospitalisations are required1.

Recurrent wheeze in preschool children is one of the most common respiratory conditions. Wheezing disorders in toddlers constitute one-third of the presentations of respiratory disorders in this age group and are associated with increased healthcare costs, loss of time from work in parents and impaired quality of life for the carers and/or the family2,3 The prevalence of preschool wheeze varies between countries. A recently published European study describes the differences in prevalence during the second year of life in nine European countries with UK having the second highest prevalence4.

In the UK, the last published national audit shows that the number of hospital admissions for preschool children with wheeze remained steadily high in the previous decade5 Recently, the first UK study looking at exacerbation rates in a general asthma population between the years 2007 and 2015 showed that the patients with the most frequent exacerbations were the group of children under 5 years old6 In Canada, the annual rate of emergency department visits is 23–42 per 1000 for preschool children with wheeze, compared with less than 15 per 1000 for those aged above six years old7 There is a similar pattern for the rate of hospital admissions.

A recent Australian study shows that nearly a third of children who present at the emergency department with a wheeze attack are discharged within 4 h and more than 40% are discharged within 7 h8, which has been reported in other studies9,10 The brevity of stay highlights that a significant number of preschool wheezers need not have sought clinical review at a secondary care setting. If we can understand why parents often seek hospital advice unnecessarily, more meaningful interventions for these patients can potentially be designed.

Patient-reported outcome measures (PROMs) are tools measuring outcomes that matter to patients. Many have been developed over the past 30 years but few are used routinely in clinical practice. Evidence shows that the systematic use of PROMs leads to better communication and decision making by doctors and patients and improves patient satisfaction and outcomes of care11 However, there are no UK PROMs for preschool children with wheeze, potentially impairing parental communication with doctors and coordination of their child’s care. We also contacted experts in management of preschool wheeze in eight different countries (UK, US, Argentina, Greece, Australia, Italy, Singapore, India) in order to identify whether any PROMs are used routinely in each country for the management of these children. We found that no PROMs have been routinely introduced in these countries either12 There are two instruments attempting to assess the severity of preschool wheeze attacks and the main parental concerns during the episode13,14 Although these instruments demonstrate how families feel during acute attacks, they do not capture the changes in quality of their life over time and are not co-designed with families as would a PROM tool15 Therefore, a PROM would potentially add significantly in the management of these children.

This paper describes the main co-developed personalised outcomes for preschool children with wheeze.