Prophylactic intermittent treatment with inhaled corticosteroids of asthma exacerbations due to airway infections in toddlers

Svedmyr, J; Nyberg, Erik; Thunqvist, P; Asbrink-Nilsson, E; Hedlin, Gunilla

doi:10.1111/j.1651-2227.1999.tb01266.x

Cited by 68 publications

(30 citation statements)

References 21 publications

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“…Previous studies regarding the prevention of episodic viral wheezing used outcome measures almost exclusively basedonparentalscoresand/orsymptoms recorded in a diary. [11][12][13] Because scores depend greatly on subjective perception, and differences exist in parents' understanding of what wheezing means, 19,20 a stronger primary endpoint was used: the incidence of wheezing diagnosed by pediatricians. Wheezing occurred less frequently in the beclomethasone group, in particular when taking into account children with a recent history of recurrent episodes, but with no statistically significant differences.…”

Section: Discussionmentioning

confidence: 99%

“…Symptoms were divided into cough, wheeze, noisy breathing, and breathlessness and were scored daily along a 4-point scale (none = 0; mild = 1; moderate = 2; severe = 3) that has been used in previous clinical trials. [11][12][13] The presence (yes/no) of airway infection symptoms (fever, blocked nose, runny nose, sore throat, and watery eyes) and the number of doses administered were also recorded daily. At the end of the treatment period, the parents expressed a judgment on the treatment (helpful versus not helpful).…”

Section: Data Collectionmentioning

confidence: 99%

“…The duration of the treatment was chosen based on the Summary of Product Characteristics and previous trials. 13 Active drug and placebo were administered by parents through a pneumatic nebulizer (Nebula, Air Liquide Medical System, Bovezzo, Italy), in the morning and in the evening. In administering the drug, 1 mL of suspension was diluted with 1 mL of saline solution.…”

Section: Treatmentmentioning

confidence: 99%

“…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. 1,14,15 Beclomethasone is the second most prescribed drug in Italian children among the medications reimbursed by the National Health Service, with a prevalence estimated ∼15% (9%-22%, depending on the setting), without changes across time.…”

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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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Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

mentioning

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Effectiveness of Nebulized Beclomethasone in Preventing Viral Wheezing: An RCT

et al. 2014

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“…Some studies have used high dose ICS (1600 mcg/day, preferably divided into four doses over the day and given for 5-10 days) as this may reduce the need for OCS. 342,458,459,484,485 However, the potential for side-effects with high dose ICS should be taken into account, especially if used repeatedly, and the child should be monitored closely. For those children already on ICS, doubling the dose was not effective in a small study in older children, 340 and there are no studies in children 5 years and younger; this approach should be reserved mainly for individual cases, and should always involve regular follow up (Evidence D).…”

Section: Inhaled Corticosteroidsmentioning

confidence: 99%