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Short acting beta agonists for recurrent wheeze in children under 2 years of age
1Kings Healthcare NHS Trust, Kings College Hospital, Bessemer Road, Denmark Hill, London, UK, SE5 9RS. chavasse@madasafish.com
Insights
Beta2-agonists (b2-agonists) offer no clear benefit for treating recurrent wheeze in infants. Further research requires defined patient groups and measurable outcomes for this common childhood respiratory symptom.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Infantile wheeze is a frequent reason for medical consultations and hospitalizations.
- Beta2-adrenoceptor agonists (b2-agonists) are commonly prescribed for wheezing but their effectiveness is uncertain.
Purpose of the Study:
- To evaluate the efficacy of b2-agonists in treating infants experiencing recurrent and persistent wheeze.
Main Methods:
- A meta-analysis included eight randomized controlled trials comparing b2-agonists to placebo in children under two years with recurrent wheeze.
- Studies were conducted in home, hospital, and laboratory settings.
- Primary outcomes included respiratory rate and symptom scores.
Main Results:
- Heterogeneity among studies limited comparisons.
- One study showed transient improvements in respiratory rate and oxygen saturation in the emergency department, but no effect on hospital admission.
- No significant benefit was observed for regular inhaled salbutamol in home symptom scores, though bronchial reactivity decreased.
Conclusions:
- Current evidence does not clearly support the use of b2-agonists for recurrent wheeze in infants.
- Future research should focus on well-defined patient populations and validated outcome measures.
Background:
Wheeze is a common symptom in infancy and is a common cause for both primary care consultations and hospital admission. Beta2-adrenoceptor agonists (b2-agonists) are the most frequently used as bronchodilator but their efficacy is questionable.
Objectives:
To determine the effectiveness of b2-agonist for the treatment of infants with recurrent and persistent wheeze.
Search Strategy:
Relevant trials were identified using the Cochrane Airways Group database (CENTRAL), Medline and Pubmed. The database search used the following terms: Wheeze or asthma and Infant or Child and Short acting beta-agonist or Salbutamol (variants), Albuterol, Terbutaline (variants), Orciprenaline, Fenoterol
Selection Criteria:
Randomised controlled trials comparing the effect of b2-agonist against placebo in children under 2 years of age who had had two or more previous episodes of wheeze, not related to another form of chronic lung disease.
Data Collection And Analysis:
Eight studies met the criteria for inclusion in this meta-analysis. The studies investigated patients in three settings: at home (3 studies), in hospital (2 studies) and in the pulmonary function laboratory (3 studies). The main outcome measure was change in respiratory rate except for community based studies where symptom scores were used.
Main Results:
The studies were markedly heterogeneous and between study comparisons were limited. Improvement in respiratory rate, symptom score and oxygen saturation were noted in one study in the emergency department following two salbutamol nebulisers but this had no impact on hospital admission. There was a reduction in bronchial reactivity following salbutamol. There was no significant benefit from taking regular inhaled salbutamol on symptom scores recorded at home.
Reviewer'S Conclusions:
There is no clear benefit of using b2-agonists in the management of recurrent wheeze in the first two years of life although there is conflicting evidence. At present, further studies should only be performed if the patient group can be clearly defined and there is a suitable outcome parameter capable of measuring a response.