Bronchodilators in wheezy under 2-year-olds: when and which (if any)?

Carroll, Will; Samanth, Jyothi

doi:10.1136/archdischild-2012-303078

Cited by 6 publications

(3 citation statements)

References 29 publications

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“…Inhaled bronchodilators remain the treatment of choice for symptoms of wheeze and shortness of breath in young children, although the evidence supporting their usefulness is limited [38]. A large and well-designed randomised controlled trial in children aged 10 months to 6 years with acute virus-induced wheeze showed no beneficial effect of a 5-day course of 10-20 mg oral prednisolone once a day on duration and severity of symptoms [39].…”

Section: Treatment Of Acute Exacerbations Of Wheezementioning

confidence: 99%

Classification and pharmacological treatment of preschool wheezing: changes since 2008

et al. 2014

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Since the publication of the European Respiratory Society Task Force report in 2008, significant new evidence has become available on the classification and management of preschool wheezing disorders. In this report, an international consensus group reviews this new evidence and proposes some modifications to the recommendations made in 2008. Specifically, the consensus group acknowledges that wheeze patterns in young children vary over time and with treatment, rendering the distinction between episodic viral wheeze and multiple-trigger wheeze unclear in many patients. Inhaled corticosteroids remain first-line treatment for multiple-trigger wheeze, but may also be considered in patients with episodic viral wheeze with frequent or severe episodes, or when the clinician suspects that interval symptoms are being under reported. Any controller therapy should be viewed as a treatment trial, with scheduled close follow-up to monitor treatment effect. The group recommends discontinuing treatment if there is no benefit and taking favourable natural history into account when making decisions about long-term therapy. Oral corticosteroids are not indicated in mild-to-moderate acute wheeze episodes and should be reserved for severe exacerbations in hospitalised patients. Future research should focus on better clinical and genetic markers, as well as biomarkers, of disease severity.

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Section: Treatment Of Acute Exacerbations Of Wheezementioning

confidence: 99%

Classification and pharmacological treatment of preschool wheezing: changes since 2008

et al. 2014

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“…Despite the CPGs recommendation against the use of β 2 -AR agonist bronchodilators in infants with viral bronchiolitis, even on a trial basis [ 23 – 25 ], there is evidence that this has not had a major impact on physicians’ behaviour [ 74 , 75 ]. The rates of bronchodilator use in viral bronchiolitis range from 18% to 90% with substantial differences between countries and even among hospitals in the same country [ 64 , 67 , 76 ].…”

Section: Discussionmentioning

confidence: 99%

The use of β₂-adrenoreceptor agonists in viral bronchiolitis: scientific rationale beyond evidence-based guidelines

2020

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Despite scientific evidence proving that inhaled β2-adrenergic receptor (β2-AR) agonists can reverse bronchoconstriction in all ages, current guidelines advocate against the use of β2-AR bronchodilators in infants with viral bronchiolitis because clinical trials have not demonstrated an overall clinical benefit. However, there are many different types of viral bronchiolitis, with variations occurring at an individual and viral level. To discard a potentially helpful treatment from all children regardless of their clinical features may be unwarranted. Unfortunately, the clinical criteria to identify the infants that may benefit from bronchodilators from those who do not are not clear. Thus, we summarised the current understanding of the individual factors that may help clinicians determine the highest probability of response to β2-AR bronchodilators during viral bronchiolitis, based on the individual immunobiology, viral pathogen, host factors and clinical presentation.

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“…In principle, intermittent symptoms should be treated with intermittent therapy. Whatever the nature of wheeze, and although the evidence supporting the usefulness of these drugs in young children is limited,42 intermittent use of bronchodilators, either β2-agonists or anticholinergics delivered by a metered-dose inhaler and a spacer, is the treatment of choice for acute episodes. There is no role for nebulised therapy to deliver bronchodilator apart from in children too sick to use inhalers.…”

Section: On the Edge Of Reasonmentioning

confidence: 99%

Infantile wheeze: rethinking dogma

Benedictis

Bush

2016

Arch Dis Child

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Wheeze is a common symptom in young children and is usually associated with viral illnesses. It is a major source of morbidity and is responsible for a high consumption of healthcare and economic resources worldwide. A few children have a condition resembling classical asthma. Rarer specific conditions may have a wheezy component and should be considered in the differential diagnosis. Over the last half century, there have been many circular discussions about the best way of managing preschool wheeze. In general, intermittent wheezing should be treated with intermittent bronchodilator therapy, and a controller therapy should be prescribed for a young child with recurrent wheezing only if positively indicated, and only then if carefully monitored for efficacy. Good multidisciplinary support, attention to environmental exposition and education are essential in managing this common condition. This article analyses the pathophysiological basis of wheezing in infancy and critically discusses the evolution of the scientific progress over time in this unique field of respiratory medicine.

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Bronchodilators in wheezy under 2-year-olds: when and which (if any)?

Cited by 6 publications

References 29 publications

Classification and pharmacological treatment of preschool wheezing: changes since 2008

Classification and pharmacological treatment of preschool wheezing: changes since 2008

The use of β₂-adrenoreceptor agonists in viral bronchiolitis: scientific rationale beyond evidence-based guidelines

Infantile wheeze: rethinking dogma

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Bronchodilators in wheezy under 2-year-olds: when and which (if any)?

Cited by 6 publications

References 29 publications

Classification and pharmacological treatment of preschool wheezing: changes since 2008

Classification and pharmacological treatment of preschool wheezing: changes since 2008

The use of β2-adrenoreceptor agonists in viral bronchiolitis: scientific rationale beyond evidence-based guidelines

Infantile wheeze: rethinking dogma

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The use of β₂-adrenoreceptor agonists in viral bronchiolitis: scientific rationale beyond evidence-based guidelines