Role of corticosteroids in preschool wheeze: going, going, but not gone

Abstract

Inhaled and oral steroids are widely and benefi cially used in older children and adults, but their place in preschool and episodic (viral) wheeze is less clear. This paper reviews recommendations in the light of new clinical trials evidence. Inhaled corticosteroids do not prevent the progression from episodic wheeze to multitrigger wheeze and asthma later in childhood. They may be benefi cial to treat current symptoms in a small minority of atopic preschool children with multitrigger wheeze, especially those over 3 years old. Some in this group may benefi t from regular treatment; for the majority, there will be no benefi t. If a therapeutic trial is contemplated, then a three-stage protocol is advised, with a trial of discontinuing the medication. Oral steroids have been shown not to be useful for home or hospital treatment of episodic wheeze, but may be useful in very severe episodes needing high dependency care. There are safety issues with the use of steroids, including a possible effect on the developing alveoli. In summary, any form of steroid therapy should be used sparingly and on an individualized basis in preschool and episodic viral wheeze.