Time to Cessation of Inhaled Corticosteroid Therapy in Transient Wheezers

Background:Transient wheezers are preschool children with recurrent wheezing that resolves by age 6 years. In cases of frequent or severe exacerbations, maintenance inhaled corticosteroid (ICS) therapy is often required. This study evaluated the time to ICS cessation and identified factors associated with delayed cessation.Materials and Methods:This retrospective study included children under 5 years with >3 wheezing episodes per year who received ICS therapy. The duration of ICS treatment was calculated from the initiation to the cessation of ICS use. Successful ICS cessation was defined as the absence of wheezing following discontinuation of ICS, with follow-up until at least 7 years of age. The primary outcome was time to ICS cessation, estimated using a time to event curve. Factors associated with time to ICS cessation were identified using a Weibull accelerated failure time model.Results:A total of 162 children were enrolled. The mean ages (SD) at ICS initiation and cessation were 2.7 (1.1) and 4.1 (1.1) years, respectively. The median time to achieve ICS cessation was 16.1 months. Compared with children aged >3 years, those aged <2 years had more than twice the time to ICS cessation (time ratio [TR] 2.01, 95% confidence interval [CI] 1.62-2.49). In addition, the presence of non-allergic rhinitis (NAR) was associated with a TR of 1.38 (95% CI: 1.09-1.76), suggesting that these children required 38% longer to discontinue ICS therapy than those without rhinitis.Conclusion:Among transient wheezers requiring ICS therapy, the median time to successful cessation was 16.1 months and may represent a potential upper-bound estimate. The observed time to ICS cessation likely reflects physician-driven decision-making. Younger age and NAR were associated with delayed ICS discontinuation. These findings provide real-world evidence on ICS treatment trajectories in children whose wheezing ultimately resolves and support the development of evidence-based guidelines to optimize ICS discontinuation.