The use of inhaled corticosteroids in wheezy pre-school age children : current practice and literature review

Abstract

Preschool children and infants frequently suffer wheezy episodes, mostly associated with viral respiratory tract infections. There is no evidence to support the use of maintenance low dose inhaled corticosteroids to prevent or manage episodic mild wheeze caused by such viral infections. However, infants and young children with recurrent episodic wheeze and a positive asthma risk index (i.e. risk factors associated with a predisposition for the future development of asthma) should be considered for a short, three-month trial of an inhaled corticosteroid. Failure to respond to an inhaled corticosteroid should prompt its discontinuation and not an increase in the drug dose. Persistent wheezing should suggest a possibility of an alternate diagnosis and the child should be referred for further investigations. Some recurrently wheezy infants and children simply do not respond to inhaled corticosteroids and most symptoms remit spontaneously after the age of five years, especially among those who do not have an atopic predisposition. The use of large doses of inhaled corticosteroids in young children whose wheezing persists should be discouraged due to the significant risk of long-term effects.