Intermittent Inhaled Corticosteroids in Infants with Episodic Wheezing

Bisgaard, Hans; Hermansen, Mette Northman; Loland, Lotte; Halkjær, Liselotte Brydensholt; Buchvald, Frederik

doi:10.1056/nejmoa054692

Cited by 507 publications

(389 citation statements)

References 39 publications

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“…Treatment of episodic (viral) wheeze in preschool children to reduce risk of persistent wheeze during later childhood Three randomised controlled trials (two on daily ICSs and one on intermittent use when the child was wheezy) have shown that use of ICSs in preschool children with episodic (viral) wheeze does not reduce the risk of persistent wheeze at the age of 6 yrs, and that symptoms return when steroid therapy is discontinued [41,119,120].…”

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

746

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: 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

746

759

View full text Add to dashboard Cite

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“…Em relação aos estudos sobre a utilização de CI para o tratamento da sibilância em lactentes, existem diferenças nos critérios de seleção das crianças, nas estratégias de tratamento, na coleta dos dados e nos desfechos considerados 8,[13][14][15][16][17][18][19][20][21][22][23][24][25] . Apesar disso, é possível concluir que a utilização de CI em lactentes pode, em algumas situações, possibilitar um melhor controle dos sintomas que, porém, não se sustenta após a suspensão do mesmo, ou seja, não interfere A principal limitação do presente estudo compreende o fato de as frequências de uso de CO e CI serem estimadas pelo relato dos pais ou responsáveis pela criança e não através de registros médicos, o que seria mais confiável.…”

Section: Características N (%)unclassified

Oral and inhaled corticoid treatment for wheezing in the first year of life

Alvim¹,

Nunes²,

Fernandes³

et al. 2011

J Pediatr (Rio J)

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Objective: To evaluate the prevalence of corticoid utilization for the treatment of wheezing in infants less than 12 months old and to analyze factors associated with this practice.Methods: This was a cross-sectional study that administered the validated questionnaire from the International Study on the Prevalence of Wheezing in Infants to 1,261 infants aged 12 to 15 months in Belo Horizonte, Brazil. Proportions and 95% confidence intervals were calculated and the chi-square test was used to detect associations between variables.Results: Six hundred and fifty-six (52%) infants, 53% male and 48.2% white, exhibited wheezing during the first year of life. Mean age at first episode was 5.11±2.89 months. There was a high rate of morbidity, with many emergency visits (71%) and hospitalizations (27.8%). Also common were a family history of asthma and atopic disease (32.2 to 71%) and exposure to passive smoking (41.5%) and to mould (47.3%). The prevalence rates for corticoid use, whether via oral route (48.7%) or inhaled (51.3%), were elevated and were higher in the group that suffered three or more episodes. Children suffering greater morbidity were more likely to be prescribed a corticoid (p < 0.05). Conclusion:The high frequency of corticoid use highlights the need to establish specific criteria for the treatment of wheezing in the first years of life in order to avoid extrapolation of asthma treatments to other conditions that are transitory and self-limiting and in which using corticoids could involve more risk than benefit. J Pediatr (Rio J). 2011;87(4):314-318: Infant, asthma, treatment, morbidity. ResumoObjetivo: Avaliar a frequência e os fatores associados ao uso de corticoides para o tratamento de sibilância em lactentes no 1º ano de vida.Método: Estudo transversal, realizado com o questionário validado do Estudio Internacional de Sibilancias en Lactantes, com 1.261 lactentes entre 12 e 15 meses em Belo Horizonte (MG). Foi realizado o cálculo das proporções e intervalo de confiança de 95% e teste de qui-quadrado para estudo da associação entre as variáveis.Resultados: Seiscentos e cinquenta e seis (52%) manifestaram sibilância no 1º ano de vida, sendo 53% do sexo masculino e 48,2% brancos. A média de idade do primeiro episódio foi 5,11±2,89 meses. Verificou-se elevada morbidade, com frequentes idas à emergência (71%) e hospitalizações (27,8%). Foram frequentes a história familiar de asma e atopia (32,2 a 71%), exposição a tabagismo passivo (41,5%) e mofo (47,3%). As prevalências da utilização de corticoides, tanto por via oral (48,7%) quanto inalatória (51,3%), foram elevadas e maiores no grupo com três ou mais episódios. Crianças com maior morbidade tiveram maior chance de receber uma prescrição de corticoide (p < 0,05). Conclusão:A elevada frequência de utilização de corticoides aponta para a necessidade de estabelecerem-se critérios específicos para o tratamento da sibilância nos primeiro anos de vida, para evitar a extrapolação do tratamento da asma para outras condições transitórias e autolimitada...

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“…Por outro lado, estudos realizados em crianças nos primeiros 3 anos de vida com budesonida nebulizada ou montelucaste oral de maneira intermitente demonstraram que não houve melhora significativa nos desfechos primários, como dias livres de sintomas, persistência de sibilância e redução no uso de corticosteroide oral 61,62 . Entretanto, Bacharier et al observaram que naqueles com APIm positivo, o tratamento por 1 semana com budesonida nebulizada ou montelucaste oral proporcionou menor uso de corticosteroide oral, significativa redução de episódios graves de sibilos e melhora do escore respiratório, quando comparados com as crianças que tiveram APIm negativo 62 .…”

Section: Tratamento Da Sibilância/asma Em Pré-escolaresunclassified

Wheezing in infancy: epidemiology, investigation, and treatment

Chong-Neto

2010

J Pediatr (Rio J)

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Objective: To perform a review of the epidemiological aspects of investigating and treating wheezing in infants. Sources:A search was run on MEDLINE using the keywords "wheezing," "infants," "diagnosis," "treatment," and "children," and Google was also used to search for "Estudio Internacional de Sibilancias en Lactantes." Summary of the findings:The prevalence of wheezing in infants varies greatly around the world. The factors associated with wheezing in infants are different at different research centers. Treatment of wheezing infants is still controversial and is dependent on a precise diagnosis. Clinical history and physical examination are fundamental to diagnosis. Conclusions:A standardized method could reveal data of relevance to the epidemiology and treatment of wheezing in Brazil and allow comparisons between different participating centers. J Pediatr (Rio J). 2010;86(3):171-178:Child, infant, wheezing. ResumoObjetivo: Realizar revisão de aspectos epidemiológicos, de investigação e tratamento da sibilância em lactentes. Fontes dos dados:Foram avaliados os estudos disponíveis na base de dados MEDLINE utilizando os descritores "sibilos", "lactentes", "diagnóstico", "tratamento" e "crianças", e estudos encontrados com a ferramenta Google utilizando o tema "Estudio Internacional de Sibilancias en Lactantes". Síntese dos dados:Foi observada globalmente grande variabilidade na prevalência de sibilância em lactentes. Os fatores associados à sibilância na infância diferem entre os centros. O tratamento de lactentes sibilantes ainda é controverso e depende de diagnóstico preciso. A história clínica e o exame físico são fundamentais para o diagnóstico. Conclusões:A padronização de método pode demonstrar dados relevantes sobre a epidemiologia e o tratamento da sibilância em nosso país para comparação entre os centros envolvidos. Artigo submetido em 13.07.09, aceito em 26.08.09.

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Intermittent Inhaled Corticosteroids in Infants with Episodic Wheezing

Abstract: Intermittent inhaled corticosteroid therapy had no effect on the progression from episodic to persistent wheezing and no short-term benefit during episodes of wheezing in the first three years of life. (ClinicalTrials.gov number, NCT00234390.).

Cited by 507 publications

References 39 publications

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

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

Oral and inhaled corticoid treatment for wheezing in the first year of life

Wheezing in infancy: epidemiology, investigation, and treatment

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