Frequency of Recurrent Wheezing in Children Aged within 5-Years Before and After Prophylactic Intermittent Treatment with Inhaled Budesonide
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Abstract
Background: Wheezing has been common in early childhood. The current clinical practice guidelines recommend therapeutic trials with continuous inhaled medication for 2-3 months. However, implementation in community hospitals might be problematic. Some literature has found insignificant difference between continuous and intermittent inhalation for prevention of recurrent wheezing.
Objective: To investigate the frequency of emergency room visits and hospitalizations due to severe recurrent wheezing among children ≤5 years old. Furthermore, to compare before and after the prophylactic intermittent treatment with inhaled budesonide.
Material and method: A retrospective cohort study was conducted among the children ≤5 years old whom were diagnosed as an early wheezer and became a candidate for a therapeutic trial at Theon Hospital between January 2015 and December 2019. All of them received prophylactic intermittent treatment with inhaled budesonide via spacer 200–400 mcg twice daily when having a respiratory tract illness or exposure to stimulus, and continued for 7 days or 48 hours after the symptoms or the stimuli had disappeared. Demographic and clinical data were recorded 1 year before and after the treatment. The number of emergency room visits and hospitalizations due to severe recurrent wheezing were observed, including the episode-free days. Data was compared using Mann-Whitney U test and exact probability test.
Results: Fifty-five patients enrolled the study. Most of them were male (63.6%). The mean age was 36.7±14.5 months (range 12– 60). The mean age at onset of wheezing was 22.5±13.1 months (range 5–50). Before and after the treatment, the median number of hospital visits due to severe recurrent wheezing decreased in both emergency room visits [2 (IQR 1–4) vs 0 (IQR 0–1) times/year respectively, p<0.001] and hospitalization [2 (IQR 1–3) vs 0 (IQR 0–0.5) times/year respectively, p<0.001). The median episode-free days increased from 38 days (IQR 9–87) to be 280 days (IQR 49–365, p<0.001).
Conclusion: The prophylactic intermittent treatment with inhaled budesonide via spacer could reduce the frequency of emergency room visits and hospitalizations due to severe recurrent wheezing in children ≤5 years old.
Article Details
บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
References
Wilson N, Sloper K, Silverman M. Effect of continuous treatment with topical corticosteroid on episodic viral wheeze in preschool children. Arch Dis Child. 1995;72(4):317–20.
Svedmyr J, Nyberg E, Thunqvist P, Åsbrink-Nilsson E, Hedlin G. Prophylactic intermittent treatment with inhaled corticosteroids of asthma exacerbations due to airway infections in toddlers.
Acta Paediatr. 1999;88(1):42–7.
Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood:
ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;368(9537):733–43.
Ducharme FM, Tse SM, Chauhan B. Diagnosis, management, and prognosis of preschool wheeze. Lancet. 2014;383(9928):1593–604.
สมาคมโรคระบบหายใจและเวชบำบัดวิกฤตในเด็ก, ราชวิทยาลัยกุมารแพทย์แห่งประเทศไทย. แนวทางการดูแลรักษาโรคติดเชื้อเฉียบพลันระบบหายใจในเด็ก พ.ศ. 2562. กรุงเทพฯ: บียอนด์ เอ็นเทอร์ไพรซ์; 2562.
Boyer D, Barsky E, Papantonakis CM, Pittman J, Ren CL, Esther CR, et al. Diagnostic evaluation of infants with recurrent or persistent wheezing. Ann Am Thorac Soc. 2016;13(11):2057–9.
สมาคมโรคภูมิแพ้ โรคหืด และวิทยาภูมิคุ้มกันแห่งประเทศไทย, สมาคมโรคระบบหายใจและเวชบำบัดวิกฤติในเด็ก. แนวทางการวินิจฉัยและรักษาโรคหืดในประเทศไทยสำหรับผู้ป่วยเด็ก (ฉบับย่อ) พ.ศ. 2558-2559.
Wilson NM, Silverman M. Treatment of acute, episodic asthma in preschool children using intermittent high dose inhaled steroids at home. Arch Dis Child. 1990;65(4):407–10.
Bacharier LB, Phillips BR, Zeiger RS, Szefler SJ, Martinez FD, Lemanske RF, et al. Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with
moderate-to-severe intermittent wheezing. J Allergy Clin Immunol. 2008;122(6):1127-1135.e8.
Ducharme FM, Lemire C, Noya FJD, Davis GM, Alos N, Leblond H, et al. Preemptive use of high-dose fluticasone for virus-induced wheezing in young children. N Engl J Med. 2009;360(4):339–53.
Zeiger RS, Mauger D, Bacharier LB, Guilbert TW, Martinez FD, Lemanske RF, et al. Daily or intermittent budesonide in preschool children with recurrent wheezing. N Engl J Med. 2011;365(21):1990–2001.
Connett G, Lenney W. Prevention of viral induced asthma attacks using inhaled budesonide. Arch Dis Child. 1993;68(1):85–7.
Wayne WD. Biostatistics: a foundations of analysis in the health sciences. 6th ed. New York: Wiley&Sons; 1995.
Martinez FD. Development of wheezing disorders and asthma in preschool children. Pediatrics. 2002;109(2 Suppl):362–7.