In pediatric patients ≤5 years of age, both short-term and long-term use of nebulized corticosteroids are effective and well tolerated for the management of acute and chronic asthma. A systematic review and global expert analysis were conducted to identify relevant articles on the subject. Findings from the study were published in the Journal of Allergy and Clinical Immunology: In Practice.

Recognizing that nebulized corticosteroids play an important role in the treatment of young children with asthma or virus-induced wheezing and that no uniform recommendations on the most appropriate use of these agents exist, investigators used electronic databases to locate pertinent English language articles on the topic, with no date restriction.

The analysis included studies that reported efficacy data in children ≤5 years of age, via use of a double-blind placebo-controlled or open-controlled randomized design. The terms used in the initial article search included “nebulized” (or “nebulizer”), “corticosteroid,” and “asthma.” In the second search, the terms “wheeze” or “wheezing” were used in place of the word “asthma.” All of the studies selected involved ≥40 participants (with no lower patient limit for studies on virus-induced wheezing). A total of 10 articles on asthma exacerbation, 9 on asthma maintenance, and 7 on virus-induced wheezing were identified.

Results of the analysis demonstrated that nebulized corticosteroids are at least as efficacious as oral corticosteroids in the hospital emergency department setting for the management of mild to moderate exacerbations of asthma. With respect to the maintenance of asthma, treatment with nebulized budesonide — the agent of focus in all of the trials evaluated — was associated with a significant reduction in the risk for additional asthma exacerbations, compared with cromolyn sodium, montelukast, and placebo.


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The addition of budesonide 1 mg to standard treatment for up to 5 days in children hospitalized for an exacerbation of asthma was associated with a significantly shorter length of hospital stay compared with placebo (44 h vs 80 h, respectively; P =.01). Moreover, the intermittent nebulized corticosteroid treatment of virus-induced wheezing was shown to be as effective as the use of continuous, daily treatment.

A possible weakness of the current review is the fact that it does not assess the relative efficacy of different nebulizer devices, according to the researchers. Another limitation is the fact that a number of the studies of acute asthma enrolled a mixed population of children, who were both older and younger than 5 years. The investigators concluded that the evidence from the clinical studies that were evaluated, as well as from real-world studies, demonstrates that nebulized corticosteroids are well tolerated and effective for the management of asthma in young children.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Hong JG, Wandalsen G, Murphy KR, et al. Nebulized inhaled corticosteroids in asthma treatment in children ≤5 years of age: a systematic review and global expert analysis [published online January 29, 2020]. J Allergy Clin Immunol Pract. doi:10.1016/j.jaip.2020.01.042