Intermittent Steroid Use Called OK for Wheezing
WEDNESDAY, Nov. 23 (HealthDay News) -- Preschoolers who have
recurrent wheezing episodes but not an asthma diagnosis are often
prescribed inhaled steroid medication, and new research suggests
it's OK to take those medications on an as-needed basis instead of
Respiratory illnesses frequently trigger severe wheezing in
young children, and the treatment for some of these kids -- using
inhaled steroid medications such as budesonide (Pulmicort) on a
daily basis -- might expose them to more of the drugs than
necessary, the researchers said.
"We learned that the daily, low-dose treatment regimen of inhaled budesonide was no better than a high-dose regimen used for seven days during a specific respiratory illness," said the study's lead author, Dr. Robert Zeiger, a clinical professor of pediatrics at the University of California, San Diego, and director of allergy research at Kaiser Permanente in San Diego.
"However, there are certain caveats to the findings. This is only applicable to patients similar to those studied. It would not be applicable to those with more severe wheezing episodes or those with persistent wheezing. And, parents shouldn't institute treatment for every sniffle or cold. Parents need to be instructed on when to use the treatment. They'll need to recognize past symptoms that preceded the development of a wheezing episode," Zeiger explained.
Results of the study are published in the Nov. 24 issue of the
New England Journal of Medicine. Funding for the study was provided by the U.S. National Heart, Lung, and Blood Institute and several academic institutions.
Daily use of inhaled budesonide is recommended for children
under 5 years who've had four or more wheezing episodes during the
past year, and have an increased risk of developing asthma.
"These are toddlers at high risk for asthma, but they don't have persistent symptoms. Persistent means more than twice a week. When these kids get sick, they often get very sick with respiratory symptoms," said Dr. Shean Aujla, a pediatric pulmonologist at Children's Hospital of Pittsburgh.
While inhaled steroid medications have considerably fewer side
effects than steroids taken orally, there's still concern when
using any medication in the long term in children. Previous
research has suggested that long-term use of inhaled
corticosteroids may cause a small reduction in a child's
The new study sought to assess whether or not less frequent
administration of inhaled steroids, but at higher doses than
prescribed for daily use, would be effective.
The researchers included 278 children between the ages of 12 and
53 months (1 to 4-plus years). All of the children had a high risk
of developing asthma, had recurrent wheezing episodes, and had
experienced at least one wheezing episode in the past year,
according to the study.
For one year, the children were randomly assigned to receive
either daily treatment with 0.5 milligrams (mg) of inhaled
budesonide or 1 mg twice daily for seven days at the start of a
respiratory illness similar to one that caused wheezing in the
They found no difference between the groups for the number of
wheezing episodes, the time to the first wheezing episodes or the
occurrence of adverse side effects. Children in the intermittent
treatment group received 104 milligrams less medication over a year
than children in the daily use group, according to the study.
"This study showed that in this particular population, there was no difference in using intermittent budesonide compared to daily," Aujla said.
"We see this population a lot, and they're a challenge to treat. They may only have symptoms in the winter, or when they have a cold, and many families are concerned about using medication every day," she added.
Zeiger said the intermittent use of budesonide will likely be
more convenient for parents and children, but parents "should never
take wheezing lightly," he cautioned. "It can lead to severe
exacerbations, ER visits and hospitalizations. Parents should seek
care for a child who has frequent wheezing episodes because we have
therapies that can reduce the burden of the child's illness."
Learn more about wheezing from the
U.S. National Library of Medicine.
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