Episodic viral wheeze in preschool children: effect of topical nasal corticosteroid prophylaxis

Silverman, Michael; Wang, Meng; Hunter, G. A.; Taub, Nicholas

doi:10.1136/thorax.58.5.431

Cited by 35 publications

(27 citation statements)

References 24 publications

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“…Health status of the infants during the first year of life was assessed by weekly phone calls of research nurses to the mothers with focus on respiratory symptoms and any changes in environmental factors such as nutrition, environmental tobacco smoke exposure, childcare or immunization (3, 25). Respiratory symptoms (cough and wheeze) were assessed using a standardized scoring system that stages symptoms into four levels according to the severity, with a high sensitivity for lower respiratory tract symptoms (Table 1) (26). Upper respiratory tract symptoms without cough (e.g.…”

Section: Methodsmentioning

confidence: 99%

Mannose‐binding lectin cord blood levels and respiratory symptoms during infancy: a prospective birth cohort study

Schlapbach

Latzin

Regamey

et al. 2009

Pediatric Allergy Immunology

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Respiratory infections cause considerable morbidity during infancy. The impact of innate immunity mechanisms, such as mannose-binding lectin (MBL), on respiratory symptoms remains unclear. The aims of this study were to investigate whether cord blood MBL levels are associated with respiratory symptoms during infancy and to determine the relative contribution of MBL when compared with known risk factors. This is a prospective birth cohort study including 185 healthy term infants. MBL was measured in cord blood and categorized into tertiles. Frequency and severity of respiratory symptoms were assessed weekly until age one. Association with MBL levels was analysed using multivariable random effects Poisson regression. We observed a trend towards an increased incidence rate of severe respiratory symptoms in infants in the low MBL tertile when compared with infants in the middle MBL tertile [incidence rate ratio (IRR) = 1.59; 95% confidence interval (CI): 0.95-2.66; p = 0.076]. Surprisingly, infants in the high MBL tertile suffered significantly more from severe and total respiratory symptoms than infants in the middle MBL tertile (IRR = 1.97; 95% CI: 1.20-3.25; p = 0.008). This association was pronounced in infants of parents with asthma (IRR = 3.64; 95% CI: 1.47-9.02; p = 0.005). The relative risk associated with high MBL was similar to the risk associated with well-known risk factors such as maternal smoking or childcare. In conclusion the association between low MBL levels and increased susceptibility to common respiratory infections during infancy was weaker than that previously reported. Instead, high cord blood MBL levels may represent a so far unrecognized risk factor for respiratory morbidity in infants of asthmatic parents.

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Section: Methodsmentioning

confidence: 99%

Mannose‐binding lectin cord blood levels and respiratory symptoms during infancy: a prospective birth cohort study

Schlapbach

Latzin

Regamey

et al. 2009

Pediatric Allergy Immunology

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“…Although treatment of allergic rhinitis may help to ameliorate asthma in school-age children and adolescents, a randomised controlled trial of nasal corticosteroids in preschool children with recurrent wheeze failed to demonstrate any benefit [118].…”

Section: Nasal Corticosteroids To Reduce Episodic (Viral) Wheezementioning

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

743

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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“…Respiratory symptoms (wheeze, cough, and breathing difficulties) were assessed using a standardized symptom score with a high sensitivity for lower respiratory tract (LRT) symptoms 16 (Table 1). Wheeze was defined as a whistling or squeaky noise from the chest audible to the parents.…”

Section: Assessment Of Respiratory Symptomsmentioning

confidence: 99%

Prospectively assessed incidence, severity, and determinants of respiratory symptoms in the first year of life

Latzin

Frey

Roiha

et al. 2006

Pediatric Pulmonology

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Summary. Respiratory symptoms are common in infancy. Nevertheless, few prospective birth cohort studies have studied the epidemiology of respiratory symptoms in normal infants. The aim of this study was to prospectively obtain reliable data on incidence, severity, and determinants of common respiratory symptoms (including cough and wheeze) in normal infants and to determine factors associated with these symptoms. In a prospective population-based birth cohort, we assessed respiratory symptoms during the first year of life by weekly phone calls to the mothers. Poisson regression was used to examine the association between symptoms and various risk factors. In the first year of life, respiratory symptoms occurred in 181/195 infants (93%), more severe symptoms in 89 (46%). The average infant had respiratory symptoms for 4 weeks and 90% had symptoms for less than 12 weeks (range 0 to 23). Male sex, higher birth weight, maternal asthma, having older siblings and nursery care were associated with more, maternal hay fever with fewer respiratory symptoms. The association with prenatal maternal smoking decreased with time since birth. This study provides reliable data on the frequency of cough and wheeze during the first year of life in healthy infants; this may help in the interpretation of published hospital and community-based studies. The apparently reduced risk in children of mothers with hayfever but no asthma, and the decreasing effect of prenatal smoke exposure over time illustrate the complexity of respiratory pathology in the first year of life. Pediatr Pulmonol. 2007; 42:41-50.

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Episodic viral wheeze in preschool children: effect of topical nasal corticosteroid prophylaxis

Cited by 35 publications

References 24 publications

Mannose‐binding lectin cord blood levels and respiratory symptoms during infancy: a prospective birth cohort study

Mannose‐binding lectin cord blood levels and respiratory symptoms during infancy: a prospective birth cohort study

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

Prospectively assessed incidence, severity, and determinants of respiratory symptoms in the first year of life

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