TY - JOUR
T1 - Do oral corticosteroids reduce the severity of acute lower respiratory tract illnesses in preschool children with recurrent wheezing?
AU - Beigelman, Avraham
AU - King, Tonya S.
AU - Mauger, David
AU - Zeiger, Robert S.
AU - Strunk, Robert C.
AU - Kelly, H. William
AU - Martinez, Fernando D.
AU - Lemanske, Robert F.
AU - Rivera-Spoljaric, Katherine
AU - Jackson, Daniel J.
AU - Guilbert, Theresa
AU - Covar, Ronina
AU - Bacharier, Leonard B.
N1 - Funding Information:
Supported by grants 5U10HL064287, 5U10HL064288, 5U10HL064295, 5U10HL064307, 5U10HL064305, and 5U10HL064313 from the National Heart, Lung, and Blood Institute . Supported in part by Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences subaward KL2 TR000450 and by Colorado CTSA grant 1 UL1RR025780 from the National Center for Research Resources (NCRR)/National Institutes of Health (NIH) . This study was carried out in part in the General Clinical Research Centers at Washington University School of Medicine ( M01 RR00036 ), at National Jewish Health ( M01 RR00051 ), and at the University of New Mexico ( 5M01 RR00997 ).
Funding Information:
Disclosure of potential conflict of interest: A. Beigelman has received research support from the National Heart, Lung, and Blood Institute (NHLBI)/Washington University School of Medicine, an American College of Allergy, Asthma & Immunology (ACAAI) Young Investigator Award, a KL2 Award, and Washington University's ICTS award and is employed by Washington University School of Medicine. T. S. King has received research support from the NHLBI. D. Mauger has received consultancy fees from GlaxoSmithKline and Sunovion. R. S. Zeiger has received research and travel support from the NHLBI; is on the GlaxoSmithKline pediatric steering committee; has received consultancy fees from AstraZeneca, Genentech, Sunovion, GlaxoSmithKline, MedImmune, Schering-Plough, Novartis, and NHLBI/Penn State; and has received research support from Genentech, GlaxoSmithKline, Merck, Aerocrine, and MedImmune. R. C. Strunk has received research support from the NHLBI and has received consultancy fees from GlaxoSmithKline, Novartis, Merck, and AstraZeneca for work on various steering committees. H. W. Kelly has received research support from the NHLBI and has received consultancy fees from Novartis, Merck, GlaxoSmithKline, and AstraZeneca. F. D. Martinez has received consultancy fees from MedImmune; has received research support from the National Institutes of Health (NIH); and has received lecture fees and travel support from Abbott and Merck. R. F. Lemanske has received travel support and fees for participation in review activities from the NIH; has received consultancy fees from Merck, Sepracor, SA Boney and Associates, GlaxoSmithKline, the American Institute of Research, Genentech, and Double Helix Development; is employed by the University of Wisconsin School of Medicine and Public Health; has received research support from the NHLBI and Pharmaxis; has received lecture fees from the Michigan Public Health Institute, Allegheny General Hospital, the American Academy of Pediatrics, West Allegheny Health Systems, California Chapter 4 AAP, the Colorado Allergy Society, the Pennsylvania Allergy and Asthma Association, Harvard Pilgrim Health, the California Society of Allergy, the NYC Allergy Society, the World Allergy Organization, and the American College of Chest Physicians; has received payment for manuscript preparation from the American Academy of Allergy, Asthma & Immunology (AAAAI); and receives royalties from Elsevier and UpToDate. D. J. Jackson has received research support from the National Institutes of Health, AAAAI/GlaxoSmithKline, and Pharmaxis and has received consultancy fees from Gilead. T. Guilbert has received research and travel support as well as fees for review activities from the NIH; is on the American Board of Pediatrics Pediatric Pulmonary Subboard; has received consultancy fees from MedImmune, Teva, MAP Pharmaceuticals, and GlaxoSmithKline; has received research support from the Centers for Disease Control and Prevention (CDC), the US Department of Health and Human Services (DHHS), Altus Pharmaceuticals, Inspire Pharmaceuticals, the NIH, UW Medical and Education Research Committee, Abbott Laboratories, Array Biopharma, Teva, Mylan, Forest Research Institute, Hoffman-LaRoche, GlaxoSmithKline and Development Limited, and MedImmune; has received lecture fees from Merck/Schering-Plough; receives royalties from UpToDate; and has received payment for the development of educational presentations from Teva. R. Covar has received consultancy fees from United Biosource and Merck and has received research support from GlaxoSmithKline. L. B. Bacharier has received research support from the NHLBI/NIH Childhood Asthma Research and Education Network; has received consultancy fees from Aerocrine, GlaxoSmithKline, Genentech/Novartis, Merck, Schering, and Cephalon; and has received lecture fees from Aerocrine, AstraZeneca, Genentech, GlaxoSmithKline, Merck, and Schering-Plough. K. Rivera-Spoljaric declares that she has no relevant conflicts of interest.
PY - 2013/6
Y1 - 2013/6
N2 - Background: Oral corticosteroids (OCSs) are recommended for severe wheezing episodes in children. However, limited evidence supports this intervention in preschool children with outpatient wheezing illnesses. Objective: We sought to investigate whether OCSs reduce symptom scores during acute lower respiratory tract illnesses (LRTIs) in preschool children with recurrent wheeze. Methods: We performed post hoc and replication analyses in 2 outpatient cohorts of children aged 1 to 5 years with episodic wheezing participating in clinical trials. We compared symptom scores during LRTIs that were or were not treated with OCSs, adjusting for differences in disease and episode severity covariates. We stratified episodes by severity by using a propensity model. The primary outcome was the area under the curve (AUC) of total symptom scores among the more severe episodes. Results: Two hundred fifteen participants from the Acute Intervention Management Strategies trial experienced 798 acute LRTIs, 112 of which were defined as severe based on propensity scores. The AUCs of total symptom scores did not differ between the episodes that were (n = 70) and were not (n = 42) treated with OCSs (P = .46) nor was there an OCS treatment effect on individual symptom scores. Similar analyses of the Maintenance Versus Intermittent Inhaled Corticosteroids in Wheezing Toddlers trial, involving 278 participants with 133 severe LRTIs, confirmed the above findings (P = .46 for AUC of total symptoms score comparison). Conclusion: In 2 separate cohorts of preschool children with episodic wheezing, OCS treatment during clinically significant LRTIs did not reduce symptom severity during acute LRTIs, despite asthma controller medication use during most episodes. These findings need to be confirmed in a prospective randomized controlled trial.
AB - Background: Oral corticosteroids (OCSs) are recommended for severe wheezing episodes in children. However, limited evidence supports this intervention in preschool children with outpatient wheezing illnesses. Objective: We sought to investigate whether OCSs reduce symptom scores during acute lower respiratory tract illnesses (LRTIs) in preschool children with recurrent wheeze. Methods: We performed post hoc and replication analyses in 2 outpatient cohorts of children aged 1 to 5 years with episodic wheezing participating in clinical trials. We compared symptom scores during LRTIs that were or were not treated with OCSs, adjusting for differences in disease and episode severity covariates. We stratified episodes by severity by using a propensity model. The primary outcome was the area under the curve (AUC) of total symptom scores among the more severe episodes. Results: Two hundred fifteen participants from the Acute Intervention Management Strategies trial experienced 798 acute LRTIs, 112 of which were defined as severe based on propensity scores. The AUCs of total symptom scores did not differ between the episodes that were (n = 70) and were not (n = 42) treated with OCSs (P = .46) nor was there an OCS treatment effect on individual symptom scores. Similar analyses of the Maintenance Versus Intermittent Inhaled Corticosteroids in Wheezing Toddlers trial, involving 278 participants with 133 severe LRTIs, confirmed the above findings (P = .46 for AUC of total symptoms score comparison). Conclusion: In 2 separate cohorts of preschool children with episodic wheezing, OCS treatment during clinically significant LRTIs did not reduce symptom severity during acute LRTIs, despite asthma controller medication use during most episodes. These findings need to be confirmed in a prospective randomized controlled trial.
KW - Oral corticosteroids
KW - episodic wheezing
KW - preschool children
UR - http://www.scopus.com/inward/record.url?scp=84878576579&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2013.01.034
DO - 10.1016/j.jaci.2013.01.034
M3 - Article
C2 - 23498594
AN - SCOPUS:84878576579
VL - 131
SP - 1518-1525.e14
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
SN - 0091-6749
IS - 6
ER -