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Inhaled corticosteroids for recurrent respiratory symptoms in preschool children in general practice: randomized
Siebrig Schokker1, Elisabeth M W Kooi, Tjalling W de Vries
1Department of General Practice, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands. s.schokker@med.umcg.nl <s.schokker@med.umcg.nl>
Insights
Inhaled corticosteroids (ICS) offer no benefit for preschool children with recurrent respiratory symptoms. A watchful waiting approach with symptomatic treatment is recommended for managing these common childhood respiratory issues.
Area of Science:
- Pediatric Pulmonology
- General Practice
- Clinical Trials
Background:
- Inhaled corticosteroids (ICS) are effective for asthma management.
- Diagnosing asthma in preschool children with symptoms like cough and wheeze is challenging.
- The efficacy of ICS in preschool children with recurrent respiratory symptoms remains unclear.
Purpose of the Study:
- To evaluate the effectiveness of inhaled corticosteroids (ICS) in preschool children presenting with recurrent respiratory symptoms in a general practice setting.
- To determine if ICS treatment improves symptom scores and reduces the need for other interventions.
Main Methods:
- A multicenter, randomized, double-blind, placebo-controlled trial involving 96 children aged 1-5 years.
- Participants received either fluticasone propionate (200 mcg/day) or a placebo for six months.
- Primary outcome was symptom score; secondary outcomes included symptom-free days, rescue medication use, and lung function.
Main Results:
- Symptoms improved in both the ICS and placebo groups over the six-month treatment period.
- No statistically significant differences were observed between the ICS and placebo groups for the primary outcome measure (symptom score).
- Secondary endpoints, including symptom-free days and lung function, also showed no significant differences between the treatment groups.
Conclusions:
- Inhaled corticosteroid (ICS) treatment does not demonstrate a beneficial effect in preschool children with recurrent respiratory symptoms managed in general practice.
- A policy of watchful waiting combined with symptomatic treatment is recommended for this patient group.
- Healthcare providers should exercise caution regarding the potential for overtreatment with ICS in young children with these symptoms.
Background:
Therapy with inhaled corticosteroids (ICS) is beneficial in patients with asthma. However, in preschool children with symptoms like cough, wheeze, or shortness of breath diagnosing asthma is difficult. Therefore, the role of ICS in the management of preschool children with recurrent respiratory symptoms is unclear. We assessed the effectiveness of ICS in preschool children with recurrent respiratory symptoms in general practice.
Methods:
In this multicenter, randomized, double blind, placebo controlled trial, 96 children aged 1-5 years consulting their general practitioners for recurrent respiratory symptoms and in whom treatment with ICS was considered by the general practitioner were randomly allocated to receive ICS (fluticasone propionate 200 mcg/day by metered dose inhaler/spacer combination) or placebo for 6 months. Outcome assessments were carried out 1, 3, and 6 months after randomization. The primary outcome measure was the symptom score (cough, shortness of breath and wheeze during day and night) as measured by a symptom diary card. Secondary endpoints were symptom-free days, use of rescue medication, adverse events, and lung function variables as measured by the interrupter technique and forced oscillation technique.
Results:
During the 6 months treatment period, symptoms improved in both groups, with no differences between ICS and placebo. In addition, none of the secondary outcome parameters showed differences between both treatment groups.
Conclusion:
ICS treatment has no beneficial effect in preschool children with recurrent respiratory symptoms in general practice. We therefore recommend a watchful waiting policy with only symptomatic treatment in these children. General practitioners and pediatricians should be aware of the high probability of overtreatment when prescribing ICS in these children.
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