Anti-inflammatory pharmacotherapy for wheezing in preschool children.
Accumulating evidence indicates that there are at least two phenotypes of wheezing in preschool years with distinct natural history. Frequent wheezing in the first 3 years of life with risk factors for asthma (e.g., eczema, maternal asthma) predicts symptoms in older age, while infrequent viral-associated wheezing without risk factors for asthma has a benign prognosis. This systematic review summarizes evidence on the use of anti-inflammatory medications in preschool children with wheezing. Literature search was performed using Medline and the Cochrane Library. Retrieved articles were critically appraised. Episodic use of high-dose inhaled corticosteroids (>1,600 mcg/day of beclomethasone) may ameliorate severity of intermittent viral-associated wheezing. Maintenance inhaled corticosteroids can control symptoms in children with frequent wheezing associated with risk factors for asthma. Inhaled corticosteroids do not alter the natural history of wheezing even when started early in life and could have a negative impact on linear growth rate. Short courses of oral corticosteroids have been proposed as an effective measure to control exacerbations of symptoms although there is little evidence supporting their use. Some studies support the administration of non-steroidal anti-inflammatory medications (leukotriene pathway modifiers, cromones, methylxanthines) for mild frequent wheezing. Maintenance inhaled corticosteroids is the most effective measure for controlling frequent wheezing in preschool children, especially when accompanied by risk factors for asthma. This treatment does not affect the natural history of wheezing, although deceleration of linear growth rate is the most commonly recognized systemic adverse effect.
Kaditis
Athanasios G
AG
Department of Pediatrics, University of Thessaly School of Medicine, Larissa, Greece. KADITIA@hotmail.com
Winnie
Glenna
G
Syrogiannopoulos
George A
GA
D000280:Administration, Inhalation; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D017332:Cetirizine / Q000008:administration & dosage; D002675:Child, Preschool; D004205:Cromolyn Sodium / Q000008:administration & dosage; D005938:Glucocorticoids / Q000008:administration & dosage*; D006634:Histamine H1 Antagonists / Q000008:administration & dosage; D006801:Humans; D007665:Ketotifen / Q000008:administration & dosage; D017835:Nedocromil / Q000008:administration & dosage; D011379:Prognosis; D012135:Respiratory Sounds / Q000187:drug effects*; D012307:Risk Factors; D014970:Xanthines / Q000008:administration & dosage
D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D006634:Histamine H1 Antagonists; D014970:Xanthines; D017835:Nedocromil; C008514:methylxanthine; D004205:Cromolyn Sodium; D007665:Ketotifen; D017332:Cetirizine