Should a Preschool Child with Acute Episodic Wheeze be Treated with Oral Corticosteroids? A Pro/Con Debate

The Journal of Allergy and Clinical Immunology. in Practice
Avraham BeigelmanTheresa W Guilbert

Abstract

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 presch...Continue Reading

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Citations

May 30, 2017·Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række·Knut ØymarSuzanne Crowley
Jan 25, 2017·Current Opinion in Allergy and Clinical Immunology·Avraham Beigelman, Leonard B Bacharier
May 18, 2018·Paediatrics & Child Health·Brian A Kuzik
Oct 18, 2020·Archives of Disease in Childhood·Alexandra WallaceStuart R Dalziel
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Jan 21, 2019·The Journal of Allergy and Clinical Immunology·Theresa W GuilbertUNKNOWN National Heart, Lung, and Blood Institute's AsthmaNet

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