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Should a Preschool Child with Acute Episodic Wheeze be Treated with Oral Corticosteroids? A Pro/Con Debate
Avraham Beigelman1, Sandy Durrani2, Theresa W Guilbert2
1Department of Pediatrics, Washington University and St Louis Children's Hospital, St Louis, Mo.
Insights
Oral corticosteroids (OCSs) are debated for treating acute wheezing in preschoolers. While some studies show benefits for atopic children, others find no effect and note adverse events, necessitating further research.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Therapeutics
Background:
- Preschool children with acute wheezing are often treated with oral corticosteroids (OCSs), a practice based on efficacy in older populations.
- Recent studies challenge this practice, highlighting a lack of demonstrated benefit and potential adverse effects of OCSs in young children.
- The link between preschool wheezing, early atopic disease, and later asthma development supports considering OCS therapy for specific phenotypes.
Purpose of the Study:
- To summarize recent literature on the use of oral corticosteroids for acute episodic wheezing in preschool-aged children.
- To present a debate on the pros and cons of OCS use in this specific pediatric population.
- To identify the need for targeted efficacy trials in preschool wheezing phenotypes.
Main Methods:
- Review of recent scientific literature concerning oral corticosteroid efficacy in preschool wheezing.
- Analysis of arguments for and against OCS use, considering study design heterogeneity and clinical outcomes.
- Discussion of the need for phenotype-specific clinical trials.
Main Results:
- Evidence for OCS efficacy in preschool wheezing is conflicting, with some studies showing benefits in atopic children and others demonstrating no significant effect.
- Heterogeneity in study designs, dosages, and outcome measures complicates definitive conclusions.
- Concerns exist regarding potential adverse effects from repeated OCS courses in young children.
Conclusions:
- The current evidence does not allow for a definitive recommendation either for or against OCS use in all preschool children with acute wheezing.
- There is a critical need for well-designed, phenotype-targeted clinical trials to evaluate OCS efficacy and safety in preschool wheezing.
- Future research should focus on identifying preschool wheezing phenotypes most likely to respond to OCS therapy.
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 preschool-aged children with recurrent wheezing targeted at phenotypes that would be expected to respond to OCSs. This article presents a summary of recent literature regarding the use of OCSs for acute episodic wheezing in preschool-aged children and a "pro" and "con" debate for such use.
