Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with moderate-to-severe intermittent wheezing

J Allergy Clin Immunol. 2008 Dec;122(6):1127-1135.e8. doi: 10.1016/j.jaci.2008.09.029. Epub 2008 Oct 30.

Abstract

Background: Acute wheezing illnesses in preschoolers require better management strategies to reduce morbidity.

Objectives: We sought to examine the effectiveness of episodic use of an inhaled corticosteroid and a leukotriene receptor antagonist in preschoolers with intermittent wheezing.

Methods: In a randomized, double-blind, placebo-controlled 12-month trial, 238 children aged 12 to 59 months with moderate-to-severe intermittent wheezing received 7 days of either budesonide inhalation suspension (1 mg twice daily), montelukast (4 mg daily), or placebo in addition to albuterol with each identified respiratory tract illness (RTI). Proportion of episode-free days (EFDs) during the 12-month trial was the primary outcome.

Results: The 3 treatment groups did not differ in proportions of EFDs, with adjusted mean EFDs of 76% (95% CI, 70% to 81%) for budesonide, 73% (95% CI, 66% to 79%) for montelukast, and 74% (95% CI, 65% to 81%) for conventional therapy (P = .66). The 3 groups did not differ in oral corticosteroid use, health care use, quality of life, or linear growth. However, during RTIs, budesonide and montelukast therapy led to modest reductions in trouble breathing (38% [P = .003] and 37% [P = .003], respectively) and interference with activity scores (32% [P = .01] and 40% [P = .001], respectively) that were most evident in those with positive asthma predictive indices.

Conclusions: In preschool children with moderate-to-severe intermittent wheezing, episodic use of either budesonide or montelukast early in RTIs, when added to albuterol, did not increase the proportion of EFDs or decrease oral corticosteroid use over a 12-month period. However, indicators of severity of acute illnesses were reduced, particularly in children with positive asthma predictive indices.

Trial registration: ClinicalTrials.gov NCT00000622.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acetates / administration & dosage*
  • Acetates / adverse effects
  • Administration, Inhalation
  • Albuterol / administration & dosage*
  • Albuterol / adverse effects
  • Bronchodilator Agents / administration & dosage*
  • Bronchodilator Agents / adverse effects
  • Budesonide / administration & dosage*
  • Budesonide / adverse effects
  • Child, Preschool
  • Double-Blind Method
  • Female
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / adverse effects
  • Humans
  • Infant
  • Leukotriene Antagonists / administration & dosage*
  • Leukotriene Antagonists / adverse effects
  • Male
  • Quinolines / administration & dosage*
  • Quinolines / adverse effects
  • Respiratory Sounds / drug effects*
  • Respiratory Sounds / etiology
  • Respiratory Tract Diseases / complications
  • Respiratory Tract Diseases / drug therapy*

Substances

  • Acetates
  • Bronchodilator Agents
  • Glucocorticoids
  • Leukotriene Antagonists
  • Quinolines
  • Budesonide
  • montelukast
  • Albuterol

Associated data

  • ClinicalTrials.gov/NCT00000622