Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e519-e525 (doi:10.1542/peds.2008-2867)
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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 and 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.


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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]