Beclomethasone dipropionate and salbutamol by metered dose inhaler in infants and small children with recurrent wheezing

Abstract

The efficacy of beclomethasone dipropionate (BDP) to control respiratory symptoms was evaluated in 31 children under age 2 years with recurrent wheezing. The study was conducted in a double-blind, parallel, and placebo-controlled fashion. The two study groups received either salbutamol plus BDP 200 microg bid by metered dose inhaler (MDI) with a spacer, or salbutamol MDI plus a placebo. Inhaled corticosteroid (IC) and placebo were administered for 8 weeks. Patients were seen every 2 weeks as outpatients, and their progress was evaluated by clinical examination and a daily symptom score card. At the end of the study, patients in both groups had significantly decreased symptoms. No significant difference was found between BDP and placebo groups regarding clinical score, number of salbutamol doses, sleep disturbances, number of symptom-free days, feelings of insecurity of mothers regarding the infants' life due to wheezing, and mothers' perceptions of progress in their infants' respiratory symptoms. We conclude that salbutamol plus 200 microg bid of BDP inhaled from an MDI with a spacer for 8 weeks is no better than salbutamol alone for decreasing recurrent wheezing in small children under age 24 months.

Efficacy of Fluticasone Propionate on Lung Function and Symptoms in Wheezy Infants

“…Several studies have evaluated the role of inhaled steroids in the treatment of wheezy infants (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)24). Only three studies used lung function as an objective end point (11,12,24).…”

“…Moreover, it has been suggested that early introduction of ICS may have a disease-modifying effect and may prevent the development of irreversible airway obstruction (5,6). However, data from studies determining the effectiveness of inhaled steroids in infants with recurrent wheezing are equivocal (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Three studies evaluated the effect of fluticasone propionate (FP) on symptom scores in wheezy infants (13,14,16).…”

Regular vs prn nebulized treatment in wheeze preschool children

“…(27) found that preschool children with wheeze who had a family history of asthma responded to inhaled glucocorticoids with a decrease in symptoms. In contrast, other studies, albeit conducted mostly in even younger children, found no effect of treatment with regular glucocorticoids on respiratory symptoms (11, 28), regardless of whether children had risk factors for asthma (12).…”

“…Because of the heterogeneous nature of wheezing, there is no consensus on the definition of different phenotypes of preschool wheeze disorders and on their treatment (3, 5) as reflected in national and international guidelines recommendations (6, 7). Regular inhaled glucocorticoids have been shown to reduce symptoms in some studies (8–10) but not in others (11, 12). Intermittent treatment with either inhaled or systemic glucocorticoids has been tested in recent trials with conflicting results (13–16).…”