Inhaled steroids for episodic viral wheeze of childhood

McKean, Michael C; Ducharme, Francine M

doi:10.1002/14651858.cd001107

Cited by 144 publications

(115 citation statements)

References 36 publications

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“…Systematic reviews have concluded that episodic high-dose inhaled glucocorticosteroids (1,600-3,200 mg?day -1 budesonide) provide some benefit in episodic (viral) wheeze (with a 50% reduction in the requirement for oral steroids, but no effect on hospitalisation rates or duration of symptoms), but that maintenance treatment with 400 mg?day -1 beclometasone equivalent does not reduce the number or the severity of wheezing episodes in episodic (viral) wheeze [106,115]. It should be emphasised that the available evidence is based on a few small trials that may be underpowered for the detection of a treatment effect.…”

Section: Inhaled Corticosteroids In Treatment Of Symptoms Of Episodicmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

Eur Respir J

750

759

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There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis.Based on the limited evidence available, inhaled short-acting b 2 -agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop.Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit.Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

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Section: Inhaled Corticosteroids In Treatment Of Symptoms Of Episodicmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

Eur Respir J

750

759

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“…Wheezing was diagnosed by pediatricians in 47 children (9 Table 2). For 26 children, the wheezing was diagnosed during the 10-day treatment period, and for 21 children, after its end.…”

Section: Primary and Secondary Outcome Measuresmentioning

confidence: 99%

“…4 The usefulness of inhaled steroids is a matter of debate: no benefits are documented for maintenance with low doses, whereas their episodic use at a high dose may lead to a modest improvement in symptoms. [6][7][8][9][10] A systematic review by the Cochrane Collaboration regarding the use of episodic, high-dose inhaled steroids in viral wheezing prevention concluded, on the basis of the results of 2 crossover, randomized controlled trials (RCTs), that children' s parents preferred inhaled steroids to placebo (relative risk [RR]: 0.64 [95% confidence interval (CI): 0.48 to 0.87]) and observed a trend for a reduced requirement of oral corticosteroids (RR: 0.53 [95% CI: 0.27 to 1.04]). 11,12 No differences were observed concerning hospitalization rate or bronchodilator use.…”

mentioning

confidence: 99%

“…11,12 No differences were observed concerning hospitalization rate or bronchodilator use. 9 A prospective RCT included in the Cochrane Review reported that episodic, high-dose budesonide reduced the asthma symptom score (as rated by parents) but found no difference in emergency department attendance, hospitalization rate, or bronchodilator use. 13 Despite the scant evidence, nebulized steroids are widely prescribed, especially in a few countries such as Italy, for the symptomatic treatment of URTIs and/or prophylaxis of viral wheezing.…”

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confidence: 99%

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Effectiveness of Nebulized Beclomethasone in Preventing Viral Wheezing: An RCT

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Viral wheezing is common in preschool-aged children. The efficacy of inhaled steroids in preventing viral wheezing is debated. Despite this debate, nebulized beclomethasone is widely prescribed (particularly in a few countries) to children with upper respiratory tract infections. WHAT THIS STUDY ADDS:Findings from this study confirm that inhaled steroids are not effective in preventing viral wheezing. Moreover, no differences were found in the persistence of symptoms (eg, runny nose, sore throat) or in the parental perception of asthma-like symptom severity.abstract OBJECTIVE: The goal of this study was to evaluate the effectiveness of nebulized beclomethasone in preventing the recurrence of viral wheezing. METHODS:The study was designed as a randomized, double-blind, placebo-controlled trial. Outpatient children aged 1 to 5 years with at least 1 episode of viral wheezing in the last 12 months, presenting to any of 40 Italian pediatricians for an upper respiratory tract infection, were randomly allocated to receive beclomethasone 400 mg or placebo twice daily for 10 days. Medications were administered through a nebulizer. A clinical evaluation was performed by the pediatrician at the start and end of the treatment period. A subjective evaluation of symptoms and efficacy of treatment was performed by the parents. The primary endpoint was the incidence of viral wheezing diagnosed by the pediatricians during the 10-day treatment period. RESULTS:A total of 525 children were enrolled in the study, 521 of whom were visited at the end of the treatment period. Wheezing was diagnosed by the pediatricians in 47 children (9.0% [95% confidence interval: 6.7 to 11.3]), with no statistically significant differences between treatment groups (beclomethasone versus placebo relative risk: 0.61 [95% confidence interval: 0.35 to 1.08]).The treatment was considered helpful by 63% of parents (64% in the beclomethasone group vs 61% in the placebo group). In all, 46% of children still had infection symptoms at the end of the treatment period, with no differences between groups. CONCLUSIONS:The findings from this study confirm that inhaled steroids are not effective in preventing recurrence of viral wheezing. Moreover, no benefits were found in reducing symptoms of respiratory tract infections. Dr Clavenna conceptualized and designed the study, and drafted the initial manuscript; Drs Sequi and Cartabia conducted the statistical analyses, and reviewed and revised the manuscript; Drs Borghi and Fortinguerra were involved in the data management and reviewed and revised the manuscript; and Dr Bonati contributed to defining the protocol, supervised the study, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted.www.pediatrics.org/cgi

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“…El repertorio de GPC National Guideline Clearinghouse acaba de publicar la sín-tesis comparativa de estas tres GPC que abordan un mismo problema de salud 4 . Se reconocen al menos las siguientes revisiones de la Cochrane sobre intervenciones en BA: adrenalina 5 , antibióti-cos 6 , beta-2-adrenérgicos 7,8 , bromuro de ipratropio 9,10 , corticoides [11][12][13][14] , fisioterapia 15,16 , inmunoglobulinas [17][18][19] , ribavirina 20,21 , suero salino hipertónico 22 y surfactante 23 . Considerando lo anteriormente expuesto, parece importante estudiar cómo se tratan las BA en nuestro medio, evaluando su variabilidad e idoneidad.…”

Section: Introductionunclassified