Preventing exacerbations in preschoolers with recurrent wheeze: A meta-analysis

Sunitha V. Kaiser, Tram Huynh, Leonard B. Bacharier, Jennifer Rosenthal, Leigh Anne Bakel, Patricia C. Parkin, Michael D. Cabana

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

CONTEXT: Half of children experience wheezing by age 6 years, and optimal strategies for preventing severe exacerbations are not well defined. OBJECTIVE: Synthesize the evidence of the effects of daily inhaled corticosteroids (ICS), intermittent ICS, and montelukast in preventing severe exacerbations among preschool children with recurrent wheeze. DATA SOURCES: Medline (1946, 2/25/15), Embase (1947, 2/25/15), CENTRAL. STUDY SELECTION: Studies were included based on design (randomized controlled trials), population (children ≤6 years with asthma or recurrent wheeze), intervention and comparison (daily ICS vs placebo, intermittent ICS vs placebo, daily ICS vs intermittent ICS, ICS vs montelukast), and outcome (exacerbations necessitating systemic steroids). DATA EXTRACTION: Completed by 2 independent reviewers. RESULTS: Twenty-two studies (N = 4550) were included. Fifteen studies (N = 3278) compared daily ICS with placebo and showed reduced exacerbations with daily medium-dose ICS (risk ratio [RR] 0.70; 95% confidence interval [CI], 0.61-0.79; NNT = 9). Subgroup analysis of children with persistent asthma showed reduced exacerbations with daily ICS compared with placebo (8 studies, N = 2505; RR 0.56; 95% CI, 0.46-0.70; NNT = 11) and daily ICS compared with montelukast (1 study, N = 202; RR 0.59; 95% CI, 0.38-0.92). Subgroup analysis of children with intermittent asthma or viral-triggered wheezing showed reduced exacerbations with preemptive high-dose intermittent ICS compared with placebo (5 studies, N = 422; RR 0.65; 95% CI, 0.51-0.81; NNT = 6). LIMITATIONS: More studies are needed that directly compare these strategies. CONCLUSIONS: There is strong evidence to support daily ICS for preventing exacerbations in preschool children with recurrent wheeze, specifically in children with persistent asthma. For preschool children with intermittent asthma or viral-triggered wheezing, there is strong evidence to support intermittent ICS for preventing exacerbations.

Original languageEnglish (US)
Article numbere20154496
JournalPediatrics
Volume137
Issue number6
DOIs
StatePublished - Jun 1 2016

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Meta-Analysis
Adrenal Cortex Hormones
montelukast
Asthma
Placebos
Respiratory Sounds
Preschool Children
Odds Ratio
Confidence Intervals
Randomized Controlled Trials
Steroids

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Kaiser, S. V., Huynh, T., Bacharier, L. B., Rosenthal, J., Bakel, L. A., Parkin, P. C., & Cabana, M. D. (2016). Preventing exacerbations in preschoolers with recurrent wheeze: A meta-analysis. Pediatrics, 137(6), [e20154496]. https://doi.org/10.1542/peds.2015-4496

Preventing exacerbations in preschoolers with recurrent wheeze : A meta-analysis. / Kaiser, Sunitha V.; Huynh, Tram; Bacharier, Leonard B.; Rosenthal, Jennifer; Bakel, Leigh Anne; Parkin, Patricia C.; Cabana, Michael D.

In: Pediatrics, Vol. 137, No. 6, e20154496, 01.06.2016.

Research output: Contribution to journalArticle

Kaiser, SV, Huynh, T, Bacharier, LB, Rosenthal, J, Bakel, LA, Parkin, PC & Cabana, MD 2016, 'Preventing exacerbations in preschoolers with recurrent wheeze: A meta-analysis', Pediatrics, vol. 137, no. 6, e20154496. https://doi.org/10.1542/peds.2015-4496
Kaiser SV, Huynh T, Bacharier LB, Rosenthal J, Bakel LA, Parkin PC et al. Preventing exacerbations in preschoolers with recurrent wheeze: A meta-analysis. Pediatrics. 2016 Jun 1;137(6). e20154496. https://doi.org/10.1542/peds.2015-4496
Kaiser, Sunitha V. ; Huynh, Tram ; Bacharier, Leonard B. ; Rosenthal, Jennifer ; Bakel, Leigh Anne ; Parkin, Patricia C. ; Cabana, Michael D. / Preventing exacerbations in preschoolers with recurrent wheeze : A meta-analysis. In: Pediatrics. 2016 ; Vol. 137, No. 6.
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abstract = "CONTEXT: Half of children experience wheezing by age 6 years, and optimal strategies for preventing severe exacerbations are not well defined. OBJECTIVE: Synthesize the evidence of the effects of daily inhaled corticosteroids (ICS), intermittent ICS, and montelukast in preventing severe exacerbations among preschool children with recurrent wheeze. DATA SOURCES: Medline (1946, 2/25/15), Embase (1947, 2/25/15), CENTRAL. STUDY SELECTION: Studies were included based on design (randomized controlled trials), population (children ≤6 years with asthma or recurrent wheeze), intervention and comparison (daily ICS vs placebo, intermittent ICS vs placebo, daily ICS vs intermittent ICS, ICS vs montelukast), and outcome (exacerbations necessitating systemic steroids). DATA EXTRACTION: Completed by 2 independent reviewers. RESULTS: Twenty-two studies (N = 4550) were included. Fifteen studies (N = 3278) compared daily ICS with placebo and showed reduced exacerbations with daily medium-dose ICS (risk ratio [RR] 0.70; 95{\%} confidence interval [CI], 0.61-0.79; NNT = 9). Subgroup analysis of children with persistent asthma showed reduced exacerbations with daily ICS compared with placebo (8 studies, N = 2505; RR 0.56; 95{\%} CI, 0.46-0.70; NNT = 11) and daily ICS compared with montelukast (1 study, N = 202; RR 0.59; 95{\%} CI, 0.38-0.92). Subgroup analysis of children with intermittent asthma or viral-triggered wheezing showed reduced exacerbations with preemptive high-dose intermittent ICS compared with placebo (5 studies, N = 422; RR 0.65; 95{\%} CI, 0.51-0.81; NNT = 6). LIMITATIONS: More studies are needed that directly compare these strategies. CONCLUSIONS: There is strong evidence to support daily ICS for preventing exacerbations in preschool children with recurrent wheeze, specifically in children with persistent asthma. For preschool children with intermittent asthma or viral-triggered wheezing, there is strong evidence to support intermittent ICS for preventing exacerbations.",
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AU - Parkin, Patricia C.

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N2 - CONTEXT: Half of children experience wheezing by age 6 years, and optimal strategies for preventing severe exacerbations are not well defined. OBJECTIVE: Synthesize the evidence of the effects of daily inhaled corticosteroids (ICS), intermittent ICS, and montelukast in preventing severe exacerbations among preschool children with recurrent wheeze. DATA SOURCES: Medline (1946, 2/25/15), Embase (1947, 2/25/15), CENTRAL. STUDY SELECTION: Studies were included based on design (randomized controlled trials), population (children ≤6 years with asthma or recurrent wheeze), intervention and comparison (daily ICS vs placebo, intermittent ICS vs placebo, daily ICS vs intermittent ICS, ICS vs montelukast), and outcome (exacerbations necessitating systemic steroids). DATA EXTRACTION: Completed by 2 independent reviewers. RESULTS: Twenty-two studies (N = 4550) were included. Fifteen studies (N = 3278) compared daily ICS with placebo and showed reduced exacerbations with daily medium-dose ICS (risk ratio [RR] 0.70; 95% confidence interval [CI], 0.61-0.79; NNT = 9). Subgroup analysis of children with persistent asthma showed reduced exacerbations with daily ICS compared with placebo (8 studies, N = 2505; RR 0.56; 95% CI, 0.46-0.70; NNT = 11) and daily ICS compared with montelukast (1 study, N = 202; RR 0.59; 95% CI, 0.38-0.92). Subgroup analysis of children with intermittent asthma or viral-triggered wheezing showed reduced exacerbations with preemptive high-dose intermittent ICS compared with placebo (5 studies, N = 422; RR 0.65; 95% CI, 0.51-0.81; NNT = 6). LIMITATIONS: More studies are needed that directly compare these strategies. CONCLUSIONS: There is strong evidence to support daily ICS for preventing exacerbations in preschool children with recurrent wheeze, specifically in children with persistent asthma. For preschool children with intermittent asthma or viral-triggered wheezing, there is strong evidence to support intermittent ICS for preventing exacerbations.

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