title: Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with moderate-to-severe intermittent wheezing.
abstract: BACKGROUND
  Acute wheezing illnesses in preschoolers require better management strategies to reduce morbidity.
  
  
  OBJECTIVE
  We sought to examine the effectiveness of episodic use of an inhaled corticosteroid and a leukotriene receptor antagonist in preschoolers with intermittent wheezing.
  
  
  METHODS
  In a randomized, double-blind, placebo-controlled 12-month trial, 238 children aged 12 to 59 months with moderate-to-severe intermittent wheezing received 7 days of either budesonide inhalation suspension (1 mg twice daily), montelukast (4 mg daily), or placebo in addition to albuterol with each identified respiratory tract illness (RTI). Proportion of episode-free days (EFDs) during the 12-month trial was the primary outcome.
  
  
  RESULTS
  The 3 treatment groups did not differ in proportions of EFDs, with adjusted mean EFDs of 76% (95% CI, 70% to 81%) for budesonide, 73% (95% CI, 66% to 79%) for montelukast, and 74% (95% CI, 65% to 81%) for conventional therapy (P = .66). The 3 groups did not differ in oral corticosteroid use, health care use, quality of life, or linear growth. However, during RTIs, budesonide and montelukast therapy led to modest reductions in trouble breathing (38% [P = .003] and 37% [P = .003], respectively) and interference with activity scores (32% [P = .01] and 40% [P = .001], respectively) that were most evident in those with positive asthma predictive indices.
  
  
  CONCLUSIONS
  In preschool children with moderate-to-severe intermittent wheezing, episodic use of either budesonide or montelukast early in RTIs, when added to albuterol, did not increase the proportion of EFDs or decrease oral corticosteroid use over a 12-month period. However, indicators of severity of acute illnesses were reduced, particularly in children with positive asthma predictive indices.
authors.affiliation: Department of Pediatrics, Washington University and St Louis Children's Hospital, St Louis, MO 63110, USA. bacharier_L@kids.wustl.edu
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Bacharier
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Phillips
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Szefler
authors.forename: Fernando D
authors.initials: FD
authors.lastname: Martinez
authors.forename: Robert F
authors.initials: RF
authors.lastname: Lemanske
authors.forename: Christine A
authors.initials: CA
authors.lastname: Sorkness
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Bloomberg
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Morgan
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paul
authors.forename: Theresa
authors.initials: T
authors.lastname: Guilbert
authors.forename: Marzena
authors.initials: M
authors.lastname: Krawiec
authors.forename: Ronina
authors.initials: R
authors.lastname: Covar
authors.forename: Gary
authors.initials: G
authors.lastname: Larsen
authors.forename: Michael
authors.initials: M
authors.lastname: Mellon
authors.forename: Mark H
authors.initials: MH
authors.lastname: Moss
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Chinchilli
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Taussig
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
mesh_terms: D000085:Acetates / Q000008:administration & dosage* / Q000009:adverse effects; D000280:Administration, Inhalation; D000420:Albuterol / Q000008:administration & dosage* / Q000009:adverse effects; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019819:Budesonide / Q000008:administration & dosage* / Q000009:adverse effects; D002675:Child, Preschool; D003521:Cyclopropanes; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D020024:Leukotriene Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D011804:Quinolines / Q000008:administration & dosage* / Q000009:adverse effects; D012135:Respiratory Sounds / Q000187:drug effects* / Q000209:etiology; D012140:Respiratory Tract Diseases / Q000150:complications / Q000188:drug therapy*; D013440:Sulfides
chemical_list: D000085:Acetates; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D005938:Glucocorticoids; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D019819:Budesonide; C093875:montelukast; D000420:Albuterol