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

Abstract

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...

Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil

“…, 7 , 15 The use of this medication, as expected, was higher in the group of recurrent wheezing when compared to occasional wheezing, and was also higher than the use of inhaled corticosteroids. In a study of 118 infants followed-up for one year after the first wheezing episode, 37% had recurrent wheezing, even when treated with prednisolone for a short period of time.…”

“…, 7 , 15 A utilização deste medicamento, como seria esperada, foi maior no grupo de sibilantes recorrentes quando comparados aos ocasionais e também foi maior que o uso de corticosteroide inalatório. Em um estudo com 118 lactentes seguidos por um ano após o primeiro episódio de sibilância, 37% apresentaram sibilância recorrente mesmo quando tratados com prednisolona por um curto período.…”

Prevalência e características clínicas da sibilância em crianças no primeiro ano de vida, residentes na cidade de Cuiabá, Mato Grosso, Brasil1

“…The use of oral corticosteroids by the study infants was high, similar to that observed in other Brazilian studies. 5 , 7 , 15 The use of this medication, as expected, was higher in the group of recurrent wheezing when compared to occasional wheezing, and was also higher than the use of inhaled corticosteroids. In a study of 118 infants followed-up for one year after the first wheezing episode, 37% had recurrent wheezing, even when treated with prednisolone for a short period of time.…”

Oral Corticosteroid Prescribing for Children With Asthma in a Medicaid Managed Care Program

“…18 Our rates were similar to the 48.7% observed among infants with wheezing in the first year of life in the city of Belo Horizonte, Brazil. 19 We also found that the 17.1% to 21.8% prevalence of asthma diagnosis in our Medicaid-and CHIPinsured population was much greater than the 8.3% to 9.5% prevalence of current asthma reported in the 2011-2014 US National Health Interview Surveys. It is possible that our high asthma prevalence rates reflect health disparities in a low-income population, adverse impacts of air pollution in the greater Houston and Beaumont/Port Arthur area, adverse selection, with asthma patients selecting our health plan at greater rates than patients without asthma, and/or overdiagnosis of asthma among the providers in our health plan.…”