# Budesonide Given Only During Acute Respiratory Illness May Prevent Asthma Exacerbations As Effectively As Daily Budesonide in Young Children with History of Wheezing

 

 

      DynaMed Weekly Update - Volume 6, Issue 47 

Inhaled corticosteroids (ICS) have been shown to reduce wheezing and asthma exacerbations in preschool-aged children ([Pediatrics 2009 Mar;123(3):e519](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list%5Fuids=19254986&holding=caugamlib)), and daily low-dose ICS treatment is recommended for children < 5 years old with persistent asthma ([J Allergy Clin Immunol. 2007 Nov;120(5 Suppl):S94-138](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list%5Fuids=17983880&holding=caugamlib)). However, daily ICS treatment has been associated with reduced growth in young children ([N Engl J Med 2006 May 11;354(19):1985](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list%5Fuids=16687711&holding=caugamlib) ). The MIST trial evaluated the efficacy of intermittent ICS treatment for prevention of exacerbation in 278 children aged 12-53 months. Children with recurrent wheezing were randomized to inhaled budesonide 1 mg twice daily for 7 days only during respiratory tract illness (intermittent) vs. daily inhaled budesonide 0.5 mg. Inclusion criteria included at least 1 asthma exacerbation requiring systemic glucocorticoids, emergency care, or hospitalization in the previous year. Children were excluded for ≥ 6 courses of oral glucocorticoids or ≥ 2 hospitalizations for wheezing within 1 year.

A total of 213 children (76.6%) completed 1 year of follow-up. There were no significant differences in the rates of exacerbation requiring oral glucocorticoids (0.95 vs. 0.97 per patient-year) or urgent care visits for asthma (2.37 vs. 2.4 per patient-year) ([level 2 \[mid-level\] evidence](http://www.epnet.com/dynamed/levels.php)). Intermittent budesonide treatment was associated with a significant reduction in cumulative budesonide dose (mean 46 mg vs. 150 mg, p < 0.05). There were no significant differences in time to first or second asthma exacerbation, or in change in height or weight from baseline at 1-year follow-up ([N Engl J Med 2011 Nov 24;365(21):1990](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=22111718)).

For more information, see the [Asthma exacerbation in children](http://search.ebscohost.com/login.aspx?direct=true&db=dme&AN=241915&site=dynamed-live&scope=site) and [Corticosteroids for wheezing in children](http://search.ebscohost.com/login.aspx?direct=true&db=dme&AN=361088&site=dynamed-live&scope=site) topics in DynaMed.