| Sumario: | QUESTION: Are inhaled corticosteroids, given episodically or daily, effective for treatment of children with viral episodic wheeze? Data sources: Published and unpublished randomised controlled trials were identified in April 1999 by searching the Cochrane Airways Group database (which includes studies identified from searches of Medline EMBASE/Excerpta Medica, CINAHL, and hand searches of 16 core respiratory journals and the proceedings of 3 respiratory societies) using combinations of the terms asthma, wheez* (truncated), budesonide, pulmicort, beclomethasone, becotide, fluticasone, flixotide, triamcinolone, steroid, corticosteroid, glucocorticoid, inhaled, aerosolised, nebulised, child, infan*, pediatric, paediatric, and adolescen*; bibliographies of retrieved trials; and contacting authors. Study selection: Studies were included if they involved children aged 0-17 years with viral episodic wheeze (defined as >/=2 episodes of wheezing associated with clinical viral infection with minimal or no symptoms between exacerbations). Studies of children with classical chronic asthma (ie, wheezing episodes caused by stimuli other than viruses) or chronic lung disease were excluded. Data extraction: Data were extracted on study design and methods, characteristics of participants, interventions, and outcomes (main outcome was episodes requiring oral corticosteroids). Study quality was independently assessed by 2 reviewers using the Jadad score. Main results: 5 studies were included in the analysis: 3 studies examined episodic high dose inhaled steroids (n=122) and 2 examined low dose, daily maintenance inhaled corticosteroids (n= 161). Episodic corticosteroids, compared with placebo, reduced exacerbations requiring emergency department visits (1 study, n=52) (table) and were associated with higher parent preferences (2 studies, n= 120) (table); no group differences were found for exacerbations requiring oral steroids or hospital admission, severity of lower respiratory tract (LRT) symptoms, or sleep disturbance. Daily maintenance corticosteroids, compared with placebo, did not reduce exacerbations requiring oral steroids, emergency department visits, or hospital admissions; duration and severity of episodes with LRT symptoms; frequency of wheezing episodes; frequency, severity, and duration of PEF reductions; and FEV[1] changes. Conclusion: Among children with episodic viral wheeze, episodic treatment with inhaled corticosteroids reduces exacerbations requiring emergency department visits and is preferred by parents; daily maintenance treatment does not improve any outcomes. [Original article accession number: 2000059009 (research, systematic review, tables/charts)]
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