Evid Based Nurs 12:105 doi:10.1136/ebn.12.4.105
  • Treatment

Review: inhaled corticosteroids reduce wheezing and asthma exacerbations in infants and preschool children


Do inhaled corticosteroids (ICSs) reduce wheezing/asthma exacerbations (WAEs) in infants and preschool children with a previous diagnosis of wheezing or asthma?

Review scope

Included studies were randomised controlled trials (RCTs) of ⩾4 weeks of treatment that compared an ICS with placebo in infants and children ⩽5 years of age with a diagnosis of wheezing or asthma for ⩾6 months before study entry. Outcomes were WAEs (worsening symptoms that required systemic corticosteroids), withdrawal from study due to WAEs, change in symptom score, change in salbutamol(albuterol) use, and change in pulmonary function (FEV1 and peak expiratory flow [PEF]).

Review methods

Medline, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (all to Mar or second quarter 2008) were searched for RCTs. 29 RCTs {n = 3992, mean age 40 mo}* met the selection criteria. Jadad quality scores ranged from 2 to 5 (mean 3.5) out of 5.

Main results

ICSs decreased the incidence of WAEs, withdrawals from study due to WAEs, symptom scores, and inhaled β2-agonist use among children taking ICSs compared with those taking placebo (table). The reduction in WAEs was greater in infants and children with asthma than in those with wheezing (relative risk reduction 0.24, 95% CI 0.01 to 0.42). FEV1 and PEF increased more in the ICS group than the placebo group (table).

Inhaled corticosteroids (ICSs) v placebo in children with wheezing or asthma*


Inhaled corticosteroids reduce wheezing/asthma exacerbations in infants and preschool children with recurrent wheezing or asthma.

*Information provided by author.

Abstracted from

Castro-Rodriguez JA, Rodrigo GJ. Efficacy of inhaled corticosteroids in infants and preschoolers with recurrent wheezing and asthma: a systematic review with meta-analysis. Pediatrics 2009;123:e519–25.

Clinical impact ratings: Family/general practice 6/7; Paediatrics 5/7; Respirology 6/7


  • Source of funding no external funding.


There is a substantial cost to both the health system and family for children <6 years with recurrent wheeze or asthma symptoms. WAEs require office or emergency department visits, and chronic symptoms affect quality of life and family income. The meta-analysis by Castro-Rodriguez and Rodrigo of 29 recent RCTs showed that low-dose ICSs significantly reduced WAEs (in approximately 40% of patients, with a number needed to treat of 7), improved symptoms, and reduced β2-agonist use during treatment more than placebo in infants and children with asthma or troublesome recurrent wheeze.

The results support current international asthma treatment guidelines regarding use of ICSs in preschool children1 and suggest that a trial of ICSs could also be useful for those with apparently non-atopic recurrent wheeze phenotypes. The authors do, however, acknowledge that several previous studies have produced conflicting results on the benefit of ICS use in this patient group and do not suggest its use for transient milder wheeze.

This review enriches the discussion of the risks, benefits, and costs of treatment options with parents. We know that preventive low-dose ICS treatment is inexpensive and easy to administer, and this meta-analysis shows clear clinical benefits during treatment. On the other hand, there is no evidence that treatment will favourably affect the course or severity of disease or prevent asthma, and this must also be explained. We also know that steroids can cause deleterious effects on growth and that such effects are dose related.2 Because asthma phenotypes are difficult to delineate in this early age group,3 it is not simple for clinicians to know for certain whether ICSs will be effective for a child with transient wheeze or early wheeze with moderate to severe symptoms and frequent exacerbations. Hence, it seems appropriate, as the authors suggest, to trial low-dose ICSs for a determined period of risk or trigger exposure and to discontinue “if a clear and beneficial response is not obvious in 4 to 6 weeks” (p e523).


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