Regular <i>vs</i> prn nebulized treatment in wheeze preschool children

Papi, Alberto; Nicolini, Gabriele; Baraldi, Eugenio; Al, Boner; Cutrera, Renato; Rossi, G. A.; Fabbri, Leonardo M.

doi:10.1111/j.1398-9995.2009.02134.x

Cited by 63 publications

(65 citation statements)

References 43 publications

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“…13,39 However, the overall probability of a best response to ICS was only 0.40 when non-differential responders are considered, highlighting the need for personalized medicine with the “right” therapies for the “right” patients. 19 Indeed, many participants had a best response to daily LTRA or as-needed ICS.…”

Section: Discussionmentioning

confidence: 99%

Individualized therapy for persistent asthma in young children

Fitzpatrick

Jackson

Mauger

et al. 2016

Journal of Allergy and Clinical Immunology

232

217

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Background Phenotypic presentations in young children with asthma are varied and may contribute to differential responses to asthma controller medications. Methods The Individualized Therapy for Asthma in Toddlers (INFANT) study was a multicenter, randomized, double-blind, double-dummy, clinical trial in children age 12-59 months (n=300) with asthma necessitating treatment with daily controller (Step 2) therapy. Participants completed a 2-8 week run-in period followed by three crossover periods with daily inhaled corticosteroid (ICS), daily leukotriene receptor antagonist (LTRA), and as-needed ICS treatment co-administered with albuterol. The primary outcome was differential response to asthma medication based on a composite measure of asthma control. The primary analysis involved two stages: determination of differential response, and assessment of whether three pre-specified features (aeroallergen sensitization, previous exacerbations, sex) predicted differential response. Results 74% (170 of 230) of children with analyzable data had a differential response to the three treatment strategies. Within differential responders, the probability of best response was highest for daily ICS and was predicted by aeroallergen sensitization, but not exacerbation history or sex. The probability of best response to daily ICS was further increased in children with both aeroallergen sensitization and blood eosinophils ≥300/μL. In these children, daily ICS was associated with more asthma control days and fewer exacerbations compared to the other treatments. Conclusions In young children with asthma necessitating Step 2 treatment, phenotyping with aeroallergen sensitization and blood eosinophils is useful for guiding treatment selection and identifies children with a high exacerbation probability for whom treatment with daily ICS is beneficial despite possible risks of growth suppression.

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Section: Discussionmentioning

confidence: 99%

Individualized therapy for persistent asthma in young children

Fitzpatrick

Jackson

Mauger

et al. 2016

Journal of Allergy and Clinical Immunology

232

217

View full text Add to dashboard Cite

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“…Data from Papi et al 30 showed no significant difference comparing intermittent ICS with placebo (RR 0.61; 95% CI, 0.19-1.91; P = .40) or daily ICS with intermittent ICS (RR 0.33; 95% CI, 0.07-1.62; P = .17).…”

Section: Subgroup Analyses: Unclear or Mixed Wheezing Phenotypesmentioning

confidence: 95%

“…Six of these studies 31 found a benefit with daily ICS, with mean differences in percentage of SFDs ranging from 5% to 23%. Two studies that compared daily and intermittent ICS 30,39 (N = 498) found no difference in SFDs. Bacharier et al 19 found no differences in SFDs comparing intermittent ICS with intermittent montelukast or placebo.…”

Section: Other Outcomes: Symptom-free Days and Linear Growthmentioning

confidence: 96%

“…19,23,27,30,33,38 All of these studies were double-blind RCTs. Two had a crossover design: Connett and Lenney 23 (participants switched treatment arms after each URTI) and Wilson and Silverman 38 (participants switched treatment arms after 2 URTIs).…”

Section: Included Studiesmentioning

confidence: 99%

“…Seven studies comparing daily ICS with placebo (N = 1336) reported on symptom-free days (SFDs); 7,22,24,[30][31][32]37 however, few provided adequate data for metaanalysis. Six of these studies 31 found a benefit with daily ICS, with mean differences in percentage of SFDs ranging from 5% to 23%.…”

Section: Other Outcomes: Symptom-free Days and Linear Growthmentioning

confidence: 99%

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Preventing Exacerbations in Preschoolers With Recurrent Wheeze: A Meta-analysis

et al. 2016

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CONTEXT: Half of children experience wheezing by age 6 years, and optimal strategies for preventing severe exacerbations are not well defined.OBJECTIVE: Synthesize the evidence of the effects of daily inhaled corticosteroids (ICS), intermittent ICS, and montelukast in preventing severe exacerbations among preschool children with recurrent wheeze. LIMITATIONS: More studies are needed that directly compare these strategies. CONCLUSIONS:There is strong evidence to support daily ICS for preventing exacerbations in preschool children with recurrent wheeze, specifically in children with persistent asthma. For preschool children with intermittent asthma or viral-triggered wheezing, there is strong evidence to support intermittent ICS for preventing exacerbations.

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