Effect of continuous treatment with topical corticosteroid on episodic viral wheeze in preschool children.

Wilson, Nicola; Sloper, K S; Silverman, Michael

doi:10.1136/adc.72.4.317

Cited by 150 publications

(84 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, viral and bacterial products are both able to cause mediator release directly and to modulate the response to other secretory stimuli [13,14] and the mast cells or basophils from children with viral associated wheeze may be particularly sensitive to this activation mechanism. Our data provide a possible explanation as to why children with VAW, who do not appear to have chronic airways inflammation, do not respond as well to regular anti-inflammatory treatment [8].…”

Section: Discussionmentioning

confidence: 87%

“…However, many children wheeze predominantly in winter and only in association with a viral respiratory infection (viral associated wheeze, VAW) and have completely asymptomatic interval periods [7]. Many of the latter group of children obtain little or no benefit from the regular use of preventative anti-inflammatory therapy [8] and it is possible that these children have a different underlying pathophysiological mechanism that causes them to wheeze only with viral infections.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bronchoalveolar lavage findings suggest two different forms of childhood asthma

Stevenson¹,

Turner

Heaney³

et al. 1997

Clin Experimental Allergy

255

196

View full text Add to dashboard Cite

SummaryBackground It seems plausible that children with atopy and persistent asthma symptoms will, like their adult counterparts, have chronic airways inflammation. However, many young children with no other atopic features have episodic wheezing that is triggered solely by viral respiratory infections. Little is known as to whether airways inflammation occurs in these two asthma patterns during relatively asymptomatic periods. Methods Using a non-bronchoscopic bronchoalveolar lavage (BAL) procedure on children presenting for an elective surgical procedure, this study has investigated the cellular constituents of BAL fluid in children with a history of atopic asthma (AA) non-asthmatic atopic children (NAA) or viral associated wheeze (VAW). Results A total of 95 children was studied: 52 with atopic asthma (8.0 years, range 1.1-15.3, 36 male), 23 with non-asthmatic atopy (median age 8.3 years, range 1.7-13.6, 11 male) and 20 with VAW (3.1 years, range 1.0-8.2, 13 male). No complications were observed during the lavage procedure and no adverse events were noted post-operatively. Total lavage fluid recovered was similar in all groups and the total cell numbers were higher in the VAW group. Eosinophil (P< 0.005) and mast cell (/'<0.05) numbers were significantly elevated in the group with atopic asthma. Conclusions During relatively asymptomatic periods there is on-going airways inflammation, as demonstrated by eosinophil and mast cell recruitment, in children with asthma and atopy but not in children with viral associated wheeze or atopy alone. This strongly suggests that there are different underlying pathophysiologicai mechanisms in these two groups of children who wheeze.

show abstract

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Bronchoalveolar lavage findings suggest two different forms of childhood asthma

Stevenson¹,

Turner

Heaney³

et al. 1997

Clin Experimental Allergy

255

196

View full text Add to dashboard Cite

show abstract

“…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. For example, the study on the effect of maintenance treatment with ICSs in episodic (viral) wheeze analysed only 41 patients [116]. The most recent study, published only in abstract form, showed that intermittent treatment with 1.5 mg?day -1 fluticasone for f10 days for episodic (viral) wheeze reduced the severity and duration of symptoms but at a cost of slightly reduced height [117].…”

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

European Respiratory Journal

735

759

View full text Add to dashboard Cite

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.

show abstract

“…Guidelines suggest treatment with asthma medication. The effect of drugs on preschool wheeze has been judged only by change in reported symptoms [6,7]. Where cough is the sole complaint, the British Thoracic Society's recent guidelines state "criteria for defining asthma in the presence of chronic or recurrent cough have not been adequately defined" [8].…”

mentioning

confidence: 99%

Airway resistance and atopy in preschool children with wheeze and cough

McKenzie¹,

Bridge²,

Healy³

2000

Eur Respir J

View full text Add to dashboard Cite

Airway resistance and atopy in preschool children with wheeze and cough. S.A. McKenzie, P.D. Bridge, M.J.R. Healy. #ERS Journals Ltd 2000. ABSTRACT: The extent to which the measurement of airways resistance by the interrupter technique (Rint) distinguishes preschool children with previous wheeze from those with no respiratory symptoms and helps to classify subjects with persistent cough, was investigated.Rint was measured before and after salbutamol treatment in 82 children with recurrent wheeze, 58 with isolated cough and 48 with no symptoms (control subjects). Their mean age (range) was 3.7 yrs (2±<5 yrs).Median baseline Rint was higher (p<0.0001) in wheezers than in either coughers or control subjects (1.16, 0.94 and 0.88 kPa . L -1 . s -1 respectively); coughers did not differ significantly from control subjects (p=0.14). The median ratios of baseline to postsalbutamol measurements (bronchodilator response (BDR)) in the groups differed significantly (1.40, 1.27 and 1.07, p#0.01 for all), suggesting that coughers occupy an intermediate position. A BDR ratio of >1.22 had a specificity and sensitivity for wheeze of 80% and 76% respectively. Twenty-eight coughers had a BDR ratio >1.22. Wheezers' immunoglobulin E was inversely related to baseline Rint.It is concluded that measurements of airway resistance by the interrupter technique are useful for classifying preschool children with respiratory symptoms and could be used to monitor the effect of interventions. The relation between atopy and airways resistance suggests that they have separate roles in preschool wheezing. Coughers with a high bronchodilator response could represent "cough-variant" asthma in children who have baseline airway resistance by the interrupter technique measurements similar to control subjects. Whether these children develop classical asthma will only be known at follow-up later in childhood. Eur Respir J 2000; 15: 833±838.

show abstract

Effect of continuous treatment with topical corticosteroid on episodic viral wheeze in preschool children.

Cited by 150 publications

References 19 publications

Bronchoalveolar lavage findings suggest two different forms of childhood asthma

Bronchoalveolar lavage findings suggest two different forms of childhood asthma

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

Airway resistance and atopy in preschool children with wheeze and cough

Contact Info

Product

Resources

About