Advertising Disclaimer
Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e519-e525 (doi:10.1542/peds.2008-2867)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow View eLetters
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Castro-Rodriguez, J. A.
Right arrow Articles by Rodrigo, G. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Castro-Rodriguez, J. A.
Right arrow Articles by Rodrigo, G. J.
Related Collections
Right arrow Asthma
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

REVIEW ARTICLE

Efficacy of Inhaled Corticosteroids in Infants and Preschoolers With Recurrent Wheezing and Asthma: A Systematic Review With Meta-analysis

Jose A. Castro-Rodriguez, MD, PhDa, Gustavo J. Rodrigo, MDb

a Department of Pediatrics and Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
b Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo and Facultad de Medicina Claeh, Prado y Salt Lake, Punta del Este, Maldonado, Uruguay

OBJECTIVE. To compare the efficacy of inhaled corticosteroids in infants and preschoolers with recurrent wheezing or asthma.

METHODS. Randomized, prospective, controlled trials published January 1996 to March 2008 with a minimum of 4 weeks of inhaled corticosteroids versus placebo were retrieved through Medline, Embase, and Central databases. The primary outcome was wheezing/asthma exacerbations; secondary outcomes were withdrawal caused by wheezing/asthma exacerbations, changes in symptoms score, pulmonary function (peak expiratory flow and forced expiratory volume in 1 second), or albuterol use.

RESULTS. Of eighty-nine studies identified, 29 (N = 3592 subjects) met the criteria for inclusion. Patients who received inhaled corticosteroids had significantly less wheezing/asthma exacerbations than those on placebo (18.0% vs 32.1%); posthoc subgroup analysis suggests that this effect was higher in those with a diagnosis of asthma than wheeze but was independent of age (infants versus preschoolers), atopic condition, type of inhaled corticosteroid (budesonide metered-dose inhaler versus fluticasone metered-dose inhaler), mode of delivery (metered-dose inhaler versus nebulizer), and study quality (Jadad score: <4 vs ≥4) and duration (<12 vs ≥12 weeks). In addition, children treated with inhaled corticosteroids had significantly fewer withdrawals caused by wheezing/asthma exacerbations, less albuterol use, and more clinical and functional improvement than those on placebo.

CONCLUSIONS. Infants and preschoolers with recurrent wheezing or asthma had less wheezing/asthma exacerbations and improve their symptoms and lung function during treatment with inhaled corticosteroids.

Key Words: asthma and wheezing management • children

Abbreviations: ICS—inhaled corticosteroid • MDI—metered-dose inhaler • WAE—wheezing/asthma exacerbation • PEF—peak expiratory flow • FEV1—forced expiratory volume in 1 second • RR—relative risk • CI—confidence interval • NNT—number(s) needed to treat

Accepted Nov 26, 2008.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Proc Am Thorac SocHome page
A. Bush and A. Menzies-Gow
Phenotypic Differences between Pediatric and Adult Asthma
Proceedings of the ATS, December 15, 2009; 6(8): 712 - 719.
[Abstract] [Full Text] [PDF]

eLetters:

Read all eLetters

Inhaled corticosteroids in infants and preschoolers with persistent wheeze/asthma: an open issue
Giorgio L. Piacentini, et al.
Pediatrics Online, 27 Mar 2009 [Full text]
A more cautious conclusion is needed
Uwe Hasenbein, et al.
Pediatrics Online, 27 Apr 2009 [Full text]