Intermittent Budesonide in Preschool Children with Recurrent Wheezing

U.S. asthma guidelines from 2007 recommend daily inhaled corticosteroids (ICS) as first-line therapy in all patients with persistent asthma. Young children with recurrent wheezing and positive modified asthma predictive index (mAPI; defined by eczema, parental asthma, or sensitization to aeroallergens) benefit more from ICS than do nonatopic children. Even though many children wheeze only when they have viral infections, guidelines have not endorsed the use of as-needed ICS because of concerns about ongoing inflammation in the absence of symptoms.

Almost 300 preschool children (age range, 1–4 years) with recurrent wheezing and positive mAPI were randomized to receive daily low-dose ICS with nebulized budesonide (0.5 mg) nightly or intermitte…