High-dose inhaled fluticasone for virus-induced wheezing in young children
A study at five centres in Quebec, Canada, has led to the conclusion that high-dose inhaled fluticasone should not be used for the treatment of young children with virus-induced wheezing.
A total of 129 children aged 1–6 years with virus-induced wheezing were randomized to inhaled fluticasone propionate 750 µg or placebo twice daily for a maximum of 10 days, at the onset of an upper respiratory tract infection (URTI), over a period of 12 months. Treatment was started by the parents using an age-appropriate spacer with a mask or mouthpiece. Over an average of 40 weeks, rescue systemic steroid treatment was given for 8% of URTIs in the fluticasone group and 18% in the placebo group, a significant 51% reduction. Children in the fluticasone group gained significantly less height and weight. There were no differences between the group in basal cortisol level, bone mineral density or adverse events.
Prophylactive treatment with high-dose fluticasone reduced the need for rescue oral steroid, but also interfered with growth. These researchers recommend that this treatment should not be used in clinical practice until more is known about long-term toxicity.
Ducharme FM, et al. Pre-emptive use of high-dose fluticasone for virus-induced wheezing in young children. NEJM 2009;360:339– 353; Bush A. Practice imperfect—treatments for wheezing in preschoolers. Ibid:409–410 (editorial).