Pro-con debate: Inhaled corticosteroids should not be prescribed in primary care to children under two years of age - the case for

Andrew Bush, David Brendan Price

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Inhaled corticosteroids (ICS) are effective treatment for older children and adults with asthma. Pathological studies have established that eosinophilic inflammation is important especially in mild to moderate asthma, thus providing a rationale for ICS treatment. However, we have wrongly concluded in the past that early and aggressive treatment of asthma is needed to prevent irreversible scarring and airflow obstruction. We have increasing evidence from all age groups that there are non-eosinophilic asthma phenotypes, that remodelling is independent of inflammation, and that steroids do not prevent children developing progressive airflow obstruction. Asthma treatments that are valuable in adults may not be effective in children, and safe prescribing requires paediatric clinical trials. In young preschool children, the evidence for any eosinophilic airway inflammation is scant, the symptomatic benefit of inhaled steroids is meagre, and there is clear evidence that ICS do not modify the natural history. There is also the potential for steroids to interfere with the developing lung. Thus, we believe that ICS should not be prescribed in primary care for children under two years of age, and that if these children are thought to need more than intermittent therapy with beta-agonists or possibly leukotriene antagonists, specialist referral is mandatory.
Original languageEnglish
Pages (from-to)176-180
Number of pages5
JournalPrimary Care Respiratory Journal
Volume17
Issue number3
DOIs
Publication statusPublished - 1 Sep 2008

Fingerprint

Primary Health Care
Adrenal Cortex Hormones
Asthma
Steroids
Inflammation
Leukotriene Antagonists
Therapeutics
Preschool Children
Natural History
Cicatrix
Referral and Consultation
Age Groups
Clinical Trials
Pediatrics
Phenotype
Lung

Keywords

  • Administration, Inhalation
  • Adrenal Cortex Hormones
  • Asthma
  • Child, Preschool
  • Humans
  • Infant
  • Inflammation
  • Primary Health Care

Cite this

@article{cd494284ffa54a9abc85f893158d4a31,
title = "Pro-con debate: Inhaled corticosteroids should not be prescribed in primary care to children under two years of age - the case for",
abstract = "Inhaled corticosteroids (ICS) are effective treatment for older children and adults with asthma. Pathological studies have established that eosinophilic inflammation is important especially in mild to moderate asthma, thus providing a rationale for ICS treatment. However, we have wrongly concluded in the past that early and aggressive treatment of asthma is needed to prevent irreversible scarring and airflow obstruction. We have increasing evidence from all age groups that there are non-eosinophilic asthma phenotypes, that remodelling is independent of inflammation, and that steroids do not prevent children developing progressive airflow obstruction. Asthma treatments that are valuable in adults may not be effective in children, and safe prescribing requires paediatric clinical trials. In young preschool children, the evidence for any eosinophilic airway inflammation is scant, the symptomatic benefit of inhaled steroids is meagre, and there is clear evidence that ICS do not modify the natural history. There is also the potential for steroids to interfere with the developing lung. Thus, we believe that ICS should not be prescribed in primary care for children under two years of age, and that if these children are thought to need more than intermittent therapy with beta-agonists or possibly leukotriene antagonists, specialist referral is mandatory.",
keywords = "Administration, Inhalation, Adrenal Cortex Hormones, Asthma, Child, Preschool, Humans, Infant, Inflammation, Primary Health Care",
author = "Andrew Bush and Price, {David Brendan}",
year = "2008",
month = "9",
day = "1",
doi = "10.3132/pcrj.2008.00046",
language = "English",
volume = "17",
pages = "176--180",
journal = "Primary Care Respiratory Journal",
issn = "1471-4418",
publisher = "Primary Care Respiratory Society UK",
number = "3",

}

TY - JOUR

T1 - Pro-con debate

T2 - Inhaled corticosteroids should not be prescribed in primary care to children under two years of age - the case for

AU - Bush, Andrew

AU - Price, David Brendan

PY - 2008/9/1

Y1 - 2008/9/1

N2 - Inhaled corticosteroids (ICS) are effective treatment for older children and adults with asthma. Pathological studies have established that eosinophilic inflammation is important especially in mild to moderate asthma, thus providing a rationale for ICS treatment. However, we have wrongly concluded in the past that early and aggressive treatment of asthma is needed to prevent irreversible scarring and airflow obstruction. We have increasing evidence from all age groups that there are non-eosinophilic asthma phenotypes, that remodelling is independent of inflammation, and that steroids do not prevent children developing progressive airflow obstruction. Asthma treatments that are valuable in adults may not be effective in children, and safe prescribing requires paediatric clinical trials. In young preschool children, the evidence for any eosinophilic airway inflammation is scant, the symptomatic benefit of inhaled steroids is meagre, and there is clear evidence that ICS do not modify the natural history. There is also the potential for steroids to interfere with the developing lung. Thus, we believe that ICS should not be prescribed in primary care for children under two years of age, and that if these children are thought to need more than intermittent therapy with beta-agonists or possibly leukotriene antagonists, specialist referral is mandatory.

AB - Inhaled corticosteroids (ICS) are effective treatment for older children and adults with asthma. Pathological studies have established that eosinophilic inflammation is important especially in mild to moderate asthma, thus providing a rationale for ICS treatment. However, we have wrongly concluded in the past that early and aggressive treatment of asthma is needed to prevent irreversible scarring and airflow obstruction. We have increasing evidence from all age groups that there are non-eosinophilic asthma phenotypes, that remodelling is independent of inflammation, and that steroids do not prevent children developing progressive airflow obstruction. Asthma treatments that are valuable in adults may not be effective in children, and safe prescribing requires paediatric clinical trials. In young preschool children, the evidence for any eosinophilic airway inflammation is scant, the symptomatic benefit of inhaled steroids is meagre, and there is clear evidence that ICS do not modify the natural history. There is also the potential for steroids to interfere with the developing lung. Thus, we believe that ICS should not be prescribed in primary care for children under two years of age, and that if these children are thought to need more than intermittent therapy with beta-agonists or possibly leukotriene antagonists, specialist referral is mandatory.

KW - Administration, Inhalation

KW - Adrenal Cortex Hormones

KW - Asthma

KW - Child, Preschool

KW - Humans

KW - Infant

KW - Inflammation

KW - Primary Health Care

U2 - 10.3132/pcrj.2008.00046

DO - 10.3132/pcrj.2008.00046

M3 - Article

C2 - 18701970

VL - 17

SP - 176

EP - 180

JO - Primary Care Respiratory Journal

JF - Primary Care Respiratory Journal

SN - 1471-4418

IS - 3

ER -