{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:38:49Z","timestamp":1792093129883,"version":"4.4.0"},"reference-count":39,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["Centre for Research Excellence\/1170958"],"award-info":[{"award-number":["Centre for Research Excellence\/1170958"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["EL2 Investigator Grant to Marchant\/2034451"],"award-info":[{"award-number":["EL2 Investigator Grant to Marchant\/2034451"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["L3 Investigator Grant to Chang\/2025379"],"award-info":[{"award-number":["L3 Investigator Grant to Chang\/2025379"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["MRFF\/2024916"],"award-info":[{"award-number":["MRFF\/2024916"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,1,6]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Preschool wheeze and asthma are associated with substantial morbidity and impaired future lung function. Yet, wheeze is unreliably reported with high disagreement (&gt;50%) between parental and physician observations. Objectively defining wheeze and its reversibility could enable an earlier asthma diagnosis and improve preschool wheeze management.<\/jats:p>\n                    <jats:p>Our primary aim is to determine in preschool children (aged 0.5\u20136 years) suspected of asthma whether adding WheezeScan to routine clinical assessment (vs assessment without WheezeScan) improves the diagnosis of asthma. Our primary hypothesis is that using WheezeScan in preschool children suspected of asthma is associated with increased definitive asthma diagnoses in this age group. Our secondary aims are to (a) examine the effect of using WheezeScan on patient-reported outcomes (PROs) and (b) healthcare costs. Our secondary hypothesis is that using WheezeScan in preschool children suspected of asthma is associated with improved quality of life without incurring additional healthcare costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      Our multicentre prospective cohort study involves recruiting 102 preschool children suspected of asthma. WheezeScan, a user-friendly digital device, incorporates artificial intelligence to objectively define wheeze and its response to bronchodilators. Over 6\u2009weeks, parents\/caregivers use the WheezeScan two times per day and whenever wheezing is suspected. If wheeze is detected, an inhaled short-acting \u03b2\n                      <jats:sub>2<\/jats:sub>\n                      -agonist is administered and WheezeScan determines if wheeze resolves thereafter.\n                    <\/jats:p>\n                    <jats:p>Our primary endpoint is the proportion of children with a definitive asthma diagnosis, compared with baseline, based on the treating clinician\u2019s assessment using WheezeScan data. Our secondary outcomes are PROs, reflecting generic health-related quality-of-life and cough-specific (if chronic cough present) outcomes and health costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The Children\u2019s Health Queensland Human Research Ethics Committee (HREC\/23\/QCHQ\/100691) and the Queensland University of Technology Office of Research Ethics and Integrity approved the study. We will publish and share results with the academic and healthcare communities and relevant patient organisations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>Australian New Zealand Clinical Trials Registry ACTRN12623000904673.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003606","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:15:11Z","timestamp":1770300911000},"page":"e003606","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Improving the management and outcomes of preschool wheeze: protocol of a prospective multicentre cohort study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1331-3706","authenticated-orcid":false,"given":"Anne B","family":"Chang","sequence":"first","affiliation":[{"name":"Child and Maternal Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia"},{"name":"Cough, Asthma and Airways Group, Australian Centre for Health Services Innovation and School of Medicine, Queensland University of Technology, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie T","family":"Yerkovich","sequence":"additional","affiliation":[{"name":"Cough, Asthma and Airways Group, Australian Centre for Health Services Innovation and School of Medicine, Queensland University of Technology, Brisbane, Queensland, Australia"},{"name":"Menzies School of Health Research, Darwin, Northern Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1463-662X","authenticated-orcid":false,"given":"Steven","family":"McPhail","sequence":"additional","affiliation":[{"name":"School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, 1. Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Brisbane, Queensland, Australia"},{"name":"Metro South Health, Clinical Informatics Directorate, Woollongabba, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiran","family":"Selvadurai","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia"},{"name":"Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas","family":"Goyal","sequence":"additional","affiliation":[{"name":"Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia"},{"name":"Queensland Children\u2019s Hospital, South Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane","family":"George","sequence":"additional","affiliation":[{"name":"Emergency Department, Gold Coast University Hospital, Southport, Gold Coast, Australia"},{"name":"School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle B","family":"McCallum","sequence":"additional","affiliation":[{"name":"Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S","family":"Morris","sequence":"additional","affiliation":[{"name":"Child Health Division, Darwin, Northern Territory, Australia"},{"name":"Menzies School of Health Research, Casuarina, Northern Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4241-8697","authenticated-orcid":false,"given":"Hannah","family":"O\u2019farrell","sequence":"additional","affiliation":[{"name":"Child and Maternal Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia"},{"name":"School of Medicine, Queensland University of Technology, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley","family":"Versteegh","sequence":"additional","affiliation":[{"name":"Child Health Division, Darwin, Northern Territory, Australia"},{"name":"Child and Maternal Health, Menzies School of Health Research, Casuarina, Northern Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Grigg","sequence":"additional","affiliation":[{"name":"Academic Unit of Paediatrics, Queen Mary University London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9078-2357","authenticated-orcid":false,"given":"Margaret","family":"McElrea","sequence":"additional","affiliation":[{"name":"Queensland University of Technology Centre for Children\u2019s Health Research, Brisbane, Queensland, Australia"},{"name":"Department of Respiratory and Sleep Medicine, Queensland Children\u2019s Hospital, South Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Worley","sequence":"additional","affiliation":[{"name":"School of Medicine, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terase","family":"Yerkovich","sequence":"additional","affiliation":[{"name":"Parent Advisory Group Representative, Cough, Asthma and Airways Group, Australian Centre for Health Services Innovation and School of Clinical Medicine, Queensland University of Technology Faculty of Health, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne","family":"Elliot-Holmes","sequence":"additional","affiliation":[{"name":"Asthma Foundation of the Northern Territory, Darwin, Northern Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Williams","sequence":"additional","affiliation":[{"name":"Parent Advisory Group Representative, Cough, Asthma and Airways Group, Australian Centre for Health Services Innovation and School of Clinical Medicine, Queensland University of Technology, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Grimwood","sequence":"additional","affiliation":[{"name":"School of Medicine and Dentistry, Griffith University, Griffith Health, Gold Coast, Queensland, Australia"},{"name":"Child and Maternal Health, Menzies School of Health Research, Darwin, Northern Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M","family":"Marchant","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, Queensland Children\u2019s Hospital, South Brisbane, Queensland, Australia"},{"name":"Australian Centre for Health Services Innovation and School of Clinical Medicine, Queensland University of Technology Faculty of Health, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"2026101301051230000_13.1.e003606.1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.95.08111942"},{"key":"2026101301051230000_13.1.e003606.2","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/j.jaip.2018.09.016","article-title":"Phenotypes of Recurrent Wheezing in Preschool Children: Identification by Latent Class Analysis and Utility in Prediction of Future Exacerbation","volume":"7","author":"Fitzpatrick","year":"2019","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2026101301051230000_13.1.e003606.3","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/pai.13334","article-title":"Preschool wheezing and asthma in children: A systematic review of guidelines and quality appraisal with the AGREE II instrument","volume":"32","author":"Ruszczy\u0144ski","year":"2021","journal-title":"Pediatric Allergy Immunology"},{"key":"2026101301051230000_13.1.e003606.4","first-page":"1","article-title":"National surveillance of asthma: United States, 2001-2010","volume":"35","author":"Moorman","year":"2012","journal-title":"Vital Health Stat"},{"key":"2026101301051230000_13.1.e003606.5","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00624-2024","article-title":"European Respiratory Society statement on preschool wheezing disorders: updated definitions, knowledge gaps and proposed future research directions","volume":"64","author":"Makrinioti","year":"2024","journal-title":"Eur Respir J"},{"key":"2026101301051230000_13.1.e003606.6","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.anai.2020.05.018","article-title":"Prevention and treatment of recurrent viral-induced wheezing in the preschool child","volume":"125","author":"Stokes","year":"2020","journal-title":"Annals of Allergy, Asthma & Immunology"},{"key":"2026101301051230000_13.1.e003606.7","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2020.00240","article-title":"Preschool Wheezing: Trajectories and Long-Term Treatment","volume":"8","author":"Fainardi","year":"2020","journal-title":"Front Pediatr"},{"key":"2026101301051230000_13.1.e003606.8","doi-asserted-by":"publisher","DOI":"10.1136\/thorax-2024-222760"},{"key":"2026101301051230000_13.1.e003606.9","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1111\/jpc.12395","article-title":"Infant wheeze: is asthma a possibility?","volume":"49","author":"Pattemore","year":"2013","journal-title":"J Paediatr Child Health"},{"key":"2026101301051230000_13.1.e003606.10","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01499-2021","article-title":"ERS\/ATS technical standard on interpretive strategies for routine lung function tests","volume":"60","author":"Stanojevic","year":"2022","journal-title":"Eur Respir J"},{"key":"2026101301051230000_13.1.e003606.11","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.04173-2020","article-title":"European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16\u2005years","volume":"58","author":"Gaillard","year":"2021","journal-title":"Eur Respir J"},{"key":"2026101301051230000_13.1.e003606.12","unstructured":"2025 GINA Report . Global strategy for asthma management and prevention. 2025."},{"key":"2026101301051230000_13.1.e003606.13","unstructured":"Australian asthma handbook. 2022. Available: https:\/\/www.asthmahandbook.org.au\/"},{"key":"2026101301051230000_13.1.e003606.14","first-page":"360","article-title":"The wheezing child: an algorithm","volume":"44","author":"Oo","year":"2015","journal-title":"Aus J General Practitioners"},{"key":"2026101301051230000_13.1.e003606.15","doi-asserted-by":"publisher","DOI":"10.1136\/adc.82.4.327"},{"key":"2026101301051230000_13.1.e003606.16","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1111\/pai.13142","article-title":"Preschool wheezing diagnosis and management-Survey of physicians\u2019 and caregivers\u2019 perspective","volume":"31","author":"Adamiec","year":"2020","journal-title":"Pediatr Allergy Immunol"},{"key":"2026101301051230000_13.1.e003606.17","first-page":"44","article-title":"Importance of detecting wheezing in young children to minimise asthma exacerbation","volume":"8","author":"Priftis","year":"2020","journal-title":"EMJ Respiratory"},{"key":"2026101301051230000_13.1.e003606.18","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.06.00008406"},{"key":"2026101301051230000_13.1.e003606.19","doi-asserted-by":"crossref","first-page":"E199","DOI":"10.1111\/jpc.12118","article-title":"Accuracy of cough reporting by carers of Indigenous children","volume":"49","author":"Morey","year":"2013","journal-title":"J Paediatr Child Health"},{"key":"2026101301051230000_13.1.e003606.20","doi-asserted-by":"crossref","DOI":"10.1186\/s40814-021-00917-w","article-title":"The impact of a digital wheeze detector on parental disease management of pre-school children suffering from wheezing-a pilot study","volume":"7","author":"Dramburg","year":"2021","journal-title":"Pilot Feasibility Stud"},{"key":"2026101301051230000_13.1.e003606.21","unstructured":"WheezeScan. 2022. Available: https:\/\/healthcare.omron.com\/about-us\/design-philosophy\/wheezescan"},{"key":"2026101301051230000_13.1.e003606.22","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/S2213-2600(24)00008-0","article-title":"Improving the respiratory health of Indigenous peoples globally - the need, why and how","volume":"12","author":"Chang","year":"2024","journal-title":"Lancet Respir Med"},{"key":"2026101301051230000_13.1.e003606.23","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-3318"},{"key":"2026101301051230000_13.1.e003606.24","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/S2213-2600(13)70185-1","article-title":"Long-term azithromycin for Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease (Bronchiectasis Intervention Study): a multicentre, double-blind, randomised controlled trial","volume":"1","author":"Valery","year":"2013","journal-title":"Lancet Respir Med"},{"key":"2026101301051230000_13.1.e003606.25","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1016\/S0140-6736(18)31723-9","article-title":"Amoxicillin-clavulanate versus azithromycin for respiratory exacerbations in children with bronchiectasis (BEST-2): a multicentre, double-blind, non-inferiority, randomised controlled trial","volume":"392","author":"Goyal","year":"2018","journal-title":"Lancet"},{"key":"2026101301051230000_13.1.e003606.26","doi-asserted-by":"crossref","first-page":"574","DOI":"10.5694\/j.1326-5377.2010.tb03640.x","article-title":"Education intervention for childhood asthma by Indigenous Health Workers in the Torres Straits","volume":"192","author":"Valery","year":"2010","journal-title":"Med J Aust"},{"key":"2026101301051230000_13.1.e003606.27","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/S2213-2600(21)00104-1","article-title":"Duration of amoxicillin-clavulanate for protracted bacterial bronchitis in children (DACS): a multi-centre, double blind, randomised controlled trial","volume":"9","author":"Ruffles","year":"2021","journal-title":"Lancet Respir Med"},{"key":"2026101301051230000_13.1.e003606.28","doi-asserted-by":"publisher","DOI":"10.1367\/1539-4409(2003)003<0329:TPAAPP>2.0.CO;2"},{"key":"2026101301051230000_13.1.e003606.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2012.10.004"},{"key":"2026101301051230000_13.1.e003606.30","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2008.tb02046.x"},{"key":"2026101301051230000_13.1.e003606.31","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1080\/02770903.2021.1984528","article-title":"Understanding caregiver perspectives on challenges and solutions to pediatric asthma care for children with a previous hospital admission: a multi-site qualitative study","volume":"59","author":"Jones","year":"2022","journal-title":"J Asthma"},{"key":"2026101301051230000_13.1.e003606.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0220606","article-title":"The accuracy of lung auscultation in the practice of physicians and medical students","volume":"14","author":"Hafke-Dys","year":"2019","journal-title":"PLoS ONE"},{"key":"2026101301051230000_13.1.e003606.33","doi-asserted-by":"publisher","DOI":"10.1136\/adc.84.1.35"},{"key":"2026101301051230000_13.1.e003606.34","doi-asserted-by":"publisher","DOI":"10.1136\/adc.87.2.131"},{"key":"2026101301051230000_13.1.e003606.35","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2015-4496","article-title":"Preventing Exacerbations in Preschoolers With Recurrent Wheeze: A Meta-analysis","volume":"137","author":"Kaiser","year":"2016","journal-title":"Pediatrics"},{"key":"2026101301051230000_13.1.e003606.36","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1016\/S2213-2600(25)00242-5","article-title":"2025 GINA report for asthma","volume":"13","author":"Venkatesan","year":"2025","journal-title":"Lancet Respir Med"},{"key":"2026101301051230000_13.1.e003606.37","doi-asserted-by":"crossref","DOI":"10.1183\/23120541.00518-2023","article-title":"Clinical efficacy and satisfaction of a digital wheeze detector in a multicentre randomised controlled trial: the WheezeScan study","volume":"10","author":"Do","year":"2024","journal-title":"ERJ Open Res"},{"key":"2026101301051230000_13.1.e003606.38","doi-asserted-by":"crossref","unstructured":"Chang AB , Yerkovich ST , McPhail SM , et al . Improving asthma control assessment and outcomes in children with asthma using an AI-digital tool: a prospective multi-centre cohort study. ERJ Open Res 2025;01217\u20132025. doi:10.1183\/23120541.01217-2025","DOI":"10.1183\/23120541.01217-2025"},{"key":"2026101301051230000_13.1.e003606.39","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2725"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2025-003606","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T08:05:22Z","timestamp":1791878722000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2025-003606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2,5]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjresp-2025-003606"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2025-003606","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}