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Randomized controlled trial of fluticasone in preschool children with intermittent wheeze
Caroline S Pao1, Sheila A McKenzie
1Department of Respiratory Paediatrics, The Royal London Hospital, Whitechapel, London, United Kingdom.
Insights
Inhaled corticosteroids may benefit preschool children with intermittent wheeze if they have aeroallergen sensitization. Lung function improved with treatment but returned to baseline after stopping, suggesting targeted use in sensitized children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Preschool children with intermittent wheeze often receive inhaled corticosteroids (ICS) without clear evidence of benefit.
- Objective assessment of treatment response using lung function measurements is crucial.
Purpose of the Study:
- To evaluate the efficacy of fluticasone propionate in preschool children with intermittent wheeze.
- To investigate the relationship between lung function changes, serum immunoglobulin E (IgE), and aeroallergen sensitization.
Main Methods:
- A 6-week randomized controlled crossover trial of fluticasone propionate (100 µg twice daily) in children aged 2 to 5 years.
- Airway resistance measured by the interrupter technique; aeroallergen sensitization assessed by skin prick testing.
Main Results:
- Significant improvement in airway resistance in sensitized children (-16.0%, p=0.003) but not in nonsensitized children (-3.5%, p=0.1).
- Changes in resistance were not correlated with serum IgE levels.
- Lung function returned to baseline 16 weeks after discontinuing fluticasone.
Conclusions:
- Inhaled fluticasone propionate improved lung function in preschool children with intermittent wheeze and aeroallergen sensitization.
- Treatment benefit was specific to sensitized children and transient.
- Inhaled steroids may be justified for intermittent wheeze in sensitized preschool children.
Abstract:
Preschool children with intermittent wheeze are often prescribed inhaled corticosteroids, although there is no proven benefit. Measurement of airway resistance by the interrupter technique can be used to objectively assess response to treatment. If lung function improves, treatment may be justified. Children with intermittent wheeze aged 2 to