title: Preventing Exacerbations in Preschoolers With Recurrent Wheeze: A Meta-analysis.
abstract: Half of children experience wheezing by age 6 years, and optimal strategies for preventing severe exacerbations are not well defined.
  
  
  
  Synthesize the evidence of the effects of daily inhaled corticosteroids (ICS), intermittent ICS, and montelukast in preventing severe exacerbations among preschool children with recurrent wheeze.
  
  
  
  Medline (1946, 2/25/15), Embase (1947, 2/25/15), CENTRAL.
  
  
  
  Studies were included based on design (randomized controlled trials), population (children ≤6 years with asthma or recurrent wheeze), intervention and comparison (daily ICS vs placebo, intermittent ICS vs placebo, daily ICS vs intermittent ICS, ICS vs montelukast), and outcome (exacerbations necessitating systemic steroids).
  
  
  
  Completed by 2 independent reviewers.
  
  
  
  Twenty-two studies (N = 4550) were included. Fifteen studies (N = 3278) compared daily ICS with placebo and showed reduced exacerbations with daily medium-dose ICS (risk ratio [RR] 0.70; 95% confidence interval [CI], 0.61-0.79; NNT = 9). Subgroup analysis of children with persistent asthma showed reduced exacerbations with daily ICS compared with placebo (8 studies, N = 2505; RR 0.56; 95% CI, 0.46-0.70; NNT = 11) and daily ICS compared with montelukast (1 study, N = 202; RR 0.59; 95% CI, 0.38-0.92). Subgroup analysis of children with intermittent asthma or viral-triggered wheezing showed reduced exacerbations with preemptive high-dose intermittent ICS compared with placebo (5 studies, N = 422; RR 0.65; 95% CI, 0.51-0.81; NNT = 6).
  
  
  
  More studies are needed that directly compare these strategies.
  
  
  
  There is strong evidence to support daily ICS for preventing exacerbations in preschool children with recurrent wheeze, specifically in children with persistent asthma. For preschool children with intermittent asthma or viral-triggered wheezing, there is strong evidence to support intermittent ICS for preventing exacerbations.
authors.affiliation: Department of Pediatrics, sunitha.kaiser@ucsf.edu.
authors.forename: Sunitha V
authors.initials: SV
authors.lastname: Kaiser
authors.affiliation: School of Public Health, University of California, Berkeley, California;
authors.forename: Tram
authors.initials: T
authors.lastname: Huynh
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri;
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Bacharier
authors.affiliation: Department of Pediatrics, University of California, Davis, California;
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Rosenthal
authors.affiliation: Department of Pediatrics, University of Colorado, Denver, Colorado; and.
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Bakel
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Parkin
authors.affiliation: Department of Pediatrics, Phillip Lee Institute for Health Policy Studies, and Department of Epidemiology and Biostatistics, University of California, San Francisco, California;
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cabana
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000517:prevention & control; D002675:Child, Preschool; D006801:Humans; D012008:Recurrence; D012135:Respiratory Sounds; D055502:Secondary Prevention
chemical_list: D018927:Anti-Asthmatic Agents