Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with moderate-to-severe intermittent wheezing

Abstract

Background Acute wheezing illnesses in preschoolers need better management strategies to reduce morbidity. Objectives To examine the effectiveness of episodic use of an inhaled corticosteroid and a leukotriene receptor antagonist in preschoolers with intermittent wheezing. Methods In a randomized, double-blind placebo-controlled twelve-month trial, 238 children aged 12-59 months with moderate-severe intermittent wheezing received 7-days of either budesonide inhalation suspension (1mg twice daily), montelukast (4mg daily), or placebos in addition to albuterol with each identified respiratory tract illness. Proportion of episode-free days (EFDs) during the 12-month trial was the primary outcome. Results The three treatment groups did not differ in proportions of EFDs, with adjusted mean (95% CI) EFDs of 76% (70%, 81%) for budesonide, 73% (66%, 79%) for montelukast, and 74% (65%, 81%) for conventional therapy (p=0.66). The three groups did not differ in oral corticosteroid use, health care utilization, quality of life, or linear growth. However, during respiratory tract illnesses, budesonide and montelukast therapy led to modest reductions in trouble breathing [(38% (p=0.003) and 37% (p=0.003)] and interference with activity scores [32% (p=0.01) and 40% (p=0.001)], most evident in those with positive asthma predictive indices. Conclusions In preschool children with moderate-to-severe intermittent wheezing, episodic use of either budesonide or montelukast early in respiratory tract illnesses, when added to albuterol, did not increase the proportion of EFDs or decrease oral corticosteroid use over a twelve-month period. However, indicators of severity of acute illnesses were reduced, particularly in children with positive asthma predictive indices. Capsule Summary The episodic use of budesonide or montelukast in preschool children with moderate-to-severe intermittent wheezing does not increase the proportion of episode free days, but decreases symptom severity during acute respiratory tract illnesses.

Inhaled Corticosteroids in Lung Diseases

“…Although the combination BUD with the long-acting b 2 agonist (LABA) formoterol in a single inhaler has been approved in Europe and other countries for maintenance and reliever therapy, it has not been approved for this use in the United States, and recently concerns have been expressed that patients receiving this therapy are not well controlled and may have inadequately treated airways inflammation (30). The use of intermittent ICS therapy for preschool children with viral-induced wheezing is of particular interest (36)(37)(38). Two recent trials suggest that intermittent high-dose use is as effective as continuous low-dose therapy and placebo in infants and young children (37,38).…”

Global strategy for the diagnosis and management of asthma in children 5 years and younger

“…The short-term addition of a controller medication -inhaled glucocorticosteroid, leukotriene modifier, or oral glucocorticosteroid -has demonstrated no effects on wheezing symptoms or progression to asthma [94][95][96][97][98][99][100][101][102] . However, in one study treating wheezing episode with 1,500 µg of fluticasone proprionate daily for 10 days reduced the need for oral glucocorticosteroids for the episode (18% in the untreated arm versus 8% in the treated arm) 103 .…”

Wheezing in infancy: epidemiology, investigation, and treatment

“…Por outro lado, estudos realizados em crianças nos primeiros 3 anos de vida com budesonida nebulizada ou montelucaste oral de maneira intermitente demonstraram que não houve melhora significativa nos desfechos primários, como dias livres de sintomas, persistência de sibilância e redução no uso de corticosteroide oral 61,62 . Entretanto, Bacharier et al observaram que naqueles com APIm positivo, o tratamento por 1 semana com budesonida nebulizada ou montelucaste oral proporcionou menor uso de corticosteroide oral, significativa redução de episódios graves de sibilos e melhora do escore respiratório, quando comparados com as crianças que tiveram APIm negativo 62 .…”

“…Entretanto, Bacharier et al observaram que naqueles com APIm positivo, o tratamento por 1 semana com budesonida nebulizada ou montelucaste oral proporcionou menor uso de corticosteroide oral, significativa redução de episódios graves de sibilos e melhora do escore respiratório, quando comparados com as crianças que tiveram APIm negativo 62 .…”