Focus area: Physicians
Corticosteroids inhalers daily or montelukast for preschoolers with asthma or recurrent hissing breath: a systematic review.
Most international asthma guidelines recommend that children with pre-school age (≤5 years), with recurrent asthma or dyspnea, be treated with moderate daily dose inhaled corticosteroids (ICS) as a drug controller or alternatively leukotriene receptor antagonists (LTRA). There is no systematic review of the efficacy of ICS monotherapy versus LTRA in this age group.
Randomized, prospective and controlled clinical trials published by December 2017 were considered with a minimum 3-month therapy with daily ICS versus LTRA. The primary outcams were: the number of episodes of wheezing and the daily symptomatic score. The secondary ones included unplanned emergency visits, the need for systemic rescue corticosteroids (SC), hospitalization for exacerbations, pulmonary function and adverse effects.
Of the 29 studies identified, 6 studies (n = 3204 patients, 62% males, age group: 6-54 months) met the inclusion criteria; 2 were at low risk of partiality ,. Five concerned children with asthma; one to those with recurring gasps. No results were reported similarly in the six studies, not allowing a meta-analysis. Considering studies with lower risk of bias and those in open with a greater number of patients; the use of ICS has been associated with better symptom control and less exacerbation compared to the use of LTRA, as well as less use of SC systemic corticosteroids. The insufficiency of the data and their not high quality, did not allow to reach conclusions on the secondary outcams.
In preschoolers with asthma or recurrent wheezing, the daily use of ICS appears more effective than the use of LTRAs, to improve symptom control and asthma exacerbations, particularly those requiring the use of systemic rescue corticosteroids.
Pediatr Pulmonol. 2018 Nov 5. doi: 10.1002/ppul.24176
Castro-Rodriguez JA, Rodriguez-Martinez CE, Ducharme FM.