TY - JOUR
T1 - Should a Preschool Child with Acute Episodic Wheeze be Treated with Oral Corticosteroids? A Pro/Con Debate
AU - Beigelman, Avraham
AU - Durrani, Sandy
AU - Guilbert, Theresa W.
N1 - Funding Information:
Conflicts of interest: A. Beigelman has received research support from the National Heart, Lung, and Blood Institute/the National Institute of Allergy and Infectious Diseases/the National Institutes of Health (NIH) AsthmaNet/Inner City Asthma Consortium (ICAC). T. W. Guilbert has received personal fees for the development of Pediatric Pulmonary board exam questions from the American Board of Pediatrics, Pediatric Pulmonary Subboard; has received research support and personal fees as an advisory board member from Teva and GlaxoSmithKline; has received personal fees as an advisory board member from the Centers for Disease Control and Prevention and Merck; has received research support from the Department of Health and Human Services, the NIH, UW Madison Medical and Education Research Committee, Abbott Laboratories, Array Biopharma, Mylan, Forest Research Institute, F. Hoffman-LaRoche, MedImmune, KaloBios Pharmaceuticals, Vertex Pharmaceuticals, Roxane Laboratories and CompleWare Corporation, CF Foundation Therapeutics, and Roche/Genentech; and receives royalties from UpToDate. S. Durrani declares no relevant conflicts of interest. The authors disclose that their position for this pro/con debate article was assigned to them. This position assignment does not necessarily reflect their personal opinion regarding the utility of oral corticosteroid treatment for acute episodic wheeze among preschool children.
Publisher Copyright:
© 2015 American Academy of Allergy, Asthma & Immunology.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Traditionally, preschool-aged children with an acute wheezing episode have been treated with oral corticosteroids (OCSs) based on the efficacy of OCSs in older children and adolescents. However, this practice has been recently challenged based on the results of recent studies. The argument supporting the use of OCSs underscores the observation that many children with recurrent preschool wheezing develop atopic disease in early life which predicts both an increased risk to develop asthma in later life and response to OCS therapy. Further, review of the literature demonstrates heterogeneity of study designs, OCS dosage, interventions, study medication adherence, and settings and overall lack of predefined preschool wheezing phenotypes. The heterogeneity of these studies does not allow a definitive recommendation discouraging OCS use. Advocates against the use of OCSs in this population argue that most of studies investigating the efficacy of OCSs in acute episodic wheeze in preschool-aged children have not demonstrated beneficial effects. Moreover, repeated OCS bursts may be associated with adverse effects. Finally, both sides can agree that there is a significant need to conduct efficacy trials evaluating OCS treatment in preschool-aged children with recurrent wheezing targeted at phenotypes that would be expected to respond to OCSs. This article presents a summary of recent literature regarding the use of OCSs for acute episodic wheezing in preschool-aged children and a "pro" and "con" debate for such use.
AB - Traditionally, preschool-aged children with an acute wheezing episode have been treated with oral corticosteroids (OCSs) based on the efficacy of OCSs in older children and adolescents. However, this practice has been recently challenged based on the results of recent studies. The argument supporting the use of OCSs underscores the observation that many children with recurrent preschool wheezing develop atopic disease in early life which predicts both an increased risk to develop asthma in later life and response to OCS therapy. Further, review of the literature demonstrates heterogeneity of study designs, OCS dosage, interventions, study medication adherence, and settings and overall lack of predefined preschool wheezing phenotypes. The heterogeneity of these studies does not allow a definitive recommendation discouraging OCS use. Advocates against the use of OCSs in this population argue that most of studies investigating the efficacy of OCSs in acute episodic wheeze in preschool-aged children have not demonstrated beneficial effects. Moreover, repeated OCS bursts may be associated with adverse effects. Finally, both sides can agree that there is a significant need to conduct efficacy trials evaluating OCS treatment in preschool-aged children with recurrent wheezing targeted at phenotypes that would be expected to respond to OCSs. This article presents a summary of recent literature regarding the use of OCSs for acute episodic wheezing in preschool-aged children and a "pro" and "con" debate for such use.
UR - http://www.scopus.com/inward/record.url?scp=84953776208&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2015.10.017
DO - 10.1016/j.jaip.2015.10.017
M3 - Article
C2 - 26772924
AN - SCOPUS:84953776208
SN - 2213-2198
VL - 4
SP - 27
EP - 35
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 1
ER -