Do oral corticosteroids reduce the severity of acute lower respiratory tract illnesses in preschool children with recurrent wheezing?

Avraham Beigelman, Tonya King, David Mauger, Robert S. Zeiger, Robert C. Strunk, H. William Kelly, Fernando D. Martinez, Robert F. Lemanske, Katherine Rivera-Spoljaric, Daniel J. Jackson, Theresa Guilbert, Ronina Covar, Leonard B. Bacharier

Research output: Contribution to journalArticle

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Abstract

Background: Oral corticosteroids (OCSs) are recommended for severe wheezing episodes in children. However, limited evidence supports this intervention in preschool children with outpatient wheezing illnesses. Objective: We sought to investigate whether OCSs reduce symptom scores during acute lower respiratory tract illnesses (LRTIs) in preschool children with recurrent wheeze. Methods: We performed post hoc and replication analyses in 2 outpatient cohorts of children aged 1 to 5 years with episodic wheezing participating in clinical trials. We compared symptom scores during LRTIs that were or were not treated with OCSs, adjusting for differences in disease and episode severity covariates. We stratified episodes by severity by using a propensity model. The primary outcome was the area under the curve (AUC) of total symptom scores among the more severe episodes. Results: Two hundred fifteen participants from the Acute Intervention Management Strategies trial experienced 798 acute LRTIs, 112 of which were defined as severe based on propensity scores. The AUCs of total symptom scores did not differ between the episodes that were (n = 70) and were not (n = 42) treated with OCSs (P = .46) nor was there an OCS treatment effect on individual symptom scores. Similar analyses of the Maintenance Versus Intermittent Inhaled Corticosteroids in Wheezing Toddlers trial, involving 278 participants with 133 severe LRTIs, confirmed the above findings (P = .46 for AUC of total symptoms score comparison). Conclusion: In 2 separate cohorts of preschool children with episodic wheezing, OCS treatment during clinically significant LRTIs did not reduce symptom severity during acute LRTIs, despite asthma controller medication use during most episodes. These findings need to be confirmed in a prospective randomized controlled trial.

Original languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology
Volume131
Issue number6
DOIs
StatePublished - Jan 1 2013

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Respiratory Sounds
Preschool Children
Respiratory System
Adrenal Cortex Hormones
Area Under Curve
Outpatients
Propensity Score
Asthma
Randomized Controlled Trials
Maintenance
Clinical Trials
Therapeutics

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology

Cite this

Beigelman, Avraham ; King, Tonya ; Mauger, David ; Zeiger, Robert S. ; Strunk, Robert C. ; Kelly, H. William ; Martinez, Fernando D. ; Lemanske, Robert F. ; Rivera-Spoljaric, Katherine ; Jackson, Daniel J. ; Guilbert, Theresa ; Covar, Ronina ; Bacharier, Leonard B. / Do oral corticosteroids reduce the severity of acute lower respiratory tract illnesses in preschool children with recurrent wheezing?. In: Journal of Allergy and Clinical Immunology. 2013 ; Vol. 131, No. 6.
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title = "Do oral corticosteroids reduce the severity of acute lower respiratory tract illnesses in preschool children with recurrent wheezing?",
abstract = "Background: Oral corticosteroids (OCSs) are recommended for severe wheezing episodes in children. However, limited evidence supports this intervention in preschool children with outpatient wheezing illnesses. Objective: We sought to investigate whether OCSs reduce symptom scores during acute lower respiratory tract illnesses (LRTIs) in preschool children with recurrent wheeze. Methods: We performed post hoc and replication analyses in 2 outpatient cohorts of children aged 1 to 5 years with episodic wheezing participating in clinical trials. We compared symptom scores during LRTIs that were or were not treated with OCSs, adjusting for differences in disease and episode severity covariates. We stratified episodes by severity by using a propensity model. The primary outcome was the area under the curve (AUC) of total symptom scores among the more severe episodes. Results: Two hundred fifteen participants from the Acute Intervention Management Strategies trial experienced 798 acute LRTIs, 112 of which were defined as severe based on propensity scores. The AUCs of total symptom scores did not differ between the episodes that were (n = 70) and were not (n = 42) treated with OCSs (P = .46) nor was there an OCS treatment effect on individual symptom scores. Similar analyses of the Maintenance Versus Intermittent Inhaled Corticosteroids in Wheezing Toddlers trial, involving 278 participants with 133 severe LRTIs, confirmed the above findings (P = .46 for AUC of total symptoms score comparison). Conclusion: In 2 separate cohorts of preschool children with episodic wheezing, OCS treatment during clinically significant LRTIs did not reduce symptom severity during acute LRTIs, despite asthma controller medication use during most episodes. These findings need to be confirmed in a prospective randomized controlled trial.",
author = "Avraham Beigelman and Tonya King and David Mauger and Zeiger, {Robert S.} and Strunk, {Robert C.} and Kelly, {H. William} and Martinez, {Fernando D.} and Lemanske, {Robert F.} and Katherine Rivera-Spoljaric and Jackson, {Daniel J.} and Theresa Guilbert and Ronina Covar and Bacharier, {Leonard B.}",
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Beigelman, A, King, T, Mauger, D, Zeiger, RS, Strunk, RC, Kelly, HW, Martinez, FD, Lemanske, RF, Rivera-Spoljaric, K, Jackson, DJ, Guilbert, T, Covar, R & Bacharier, LB 2013, 'Do oral corticosteroids reduce the severity of acute lower respiratory tract illnesses in preschool children with recurrent wheezing?', Journal of Allergy and Clinical Immunology, vol. 131, no. 6. https://doi.org/10.1016/j.jaci.2013.01.034

Do oral corticosteroids reduce the severity of acute lower respiratory tract illnesses in preschool children with recurrent wheezing? / Beigelman, Avraham; King, Tonya; Mauger, David; Zeiger, Robert S.; Strunk, Robert C.; Kelly, H. William; Martinez, Fernando D.; Lemanske, Robert F.; Rivera-Spoljaric, Katherine; Jackson, Daniel J.; Guilbert, Theresa; Covar, Ronina; Bacharier, Leonard B.

In: Journal of Allergy and Clinical Immunology, Vol. 131, No. 6, 01.01.2013.

Research output: Contribution to journalArticle

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T1 - Do oral corticosteroids reduce the severity of acute lower respiratory tract illnesses in preschool children with recurrent wheezing?

AU - Beigelman, Avraham

AU - King, Tonya

AU - Mauger, David

AU - Zeiger, Robert S.

AU - Strunk, Robert C.

AU - Kelly, H. William

AU - Martinez, Fernando D.

AU - Lemanske, Robert F.

AU - Rivera-Spoljaric, Katherine

AU - Jackson, Daniel J.

AU - Guilbert, Theresa

AU - Covar, Ronina

AU - Bacharier, Leonard B.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background: Oral corticosteroids (OCSs) are recommended for severe wheezing episodes in children. However, limited evidence supports this intervention in preschool children with outpatient wheezing illnesses. Objective: We sought to investigate whether OCSs reduce symptom scores during acute lower respiratory tract illnesses (LRTIs) in preschool children with recurrent wheeze. Methods: We performed post hoc and replication analyses in 2 outpatient cohorts of children aged 1 to 5 years with episodic wheezing participating in clinical trials. We compared symptom scores during LRTIs that were or were not treated with OCSs, adjusting for differences in disease and episode severity covariates. We stratified episodes by severity by using a propensity model. The primary outcome was the area under the curve (AUC) of total symptom scores among the more severe episodes. Results: Two hundred fifteen participants from the Acute Intervention Management Strategies trial experienced 798 acute LRTIs, 112 of which were defined as severe based on propensity scores. The AUCs of total symptom scores did not differ between the episodes that were (n = 70) and were not (n = 42) treated with OCSs (P = .46) nor was there an OCS treatment effect on individual symptom scores. Similar analyses of the Maintenance Versus Intermittent Inhaled Corticosteroids in Wheezing Toddlers trial, involving 278 participants with 133 severe LRTIs, confirmed the above findings (P = .46 for AUC of total symptoms score comparison). Conclusion: In 2 separate cohorts of preschool children with episodic wheezing, OCS treatment during clinically significant LRTIs did not reduce symptom severity during acute LRTIs, despite asthma controller medication use during most episodes. These findings need to be confirmed in a prospective randomized controlled trial.

AB - Background: Oral corticosteroids (OCSs) are recommended for severe wheezing episodes in children. However, limited evidence supports this intervention in preschool children with outpatient wheezing illnesses. Objective: We sought to investigate whether OCSs reduce symptom scores during acute lower respiratory tract illnesses (LRTIs) in preschool children with recurrent wheeze. Methods: We performed post hoc and replication analyses in 2 outpatient cohorts of children aged 1 to 5 years with episodic wheezing participating in clinical trials. We compared symptom scores during LRTIs that were or were not treated with OCSs, adjusting for differences in disease and episode severity covariates. We stratified episodes by severity by using a propensity model. The primary outcome was the area under the curve (AUC) of total symptom scores among the more severe episodes. Results: Two hundred fifteen participants from the Acute Intervention Management Strategies trial experienced 798 acute LRTIs, 112 of which were defined as severe based on propensity scores. The AUCs of total symptom scores did not differ between the episodes that were (n = 70) and were not (n = 42) treated with OCSs (P = .46) nor was there an OCS treatment effect on individual symptom scores. Similar analyses of the Maintenance Versus Intermittent Inhaled Corticosteroids in Wheezing Toddlers trial, involving 278 participants with 133 severe LRTIs, confirmed the above findings (P = .46 for AUC of total symptoms score comparison). Conclusion: In 2 separate cohorts of preschool children with episodic wheezing, OCS treatment during clinically significant LRTIs did not reduce symptom severity during acute LRTIs, despite asthma controller medication use during most episodes. These findings need to be confirmed in a prospective randomized controlled trial.

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