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Children aged five and under – particularly those with intermittent viral-induced wheezing – should be treated with oral corticosteroids for asthma only if their wheeze is severe enough to require hospital admission, according to new guidelines.

The Thoracic Society of Australia and New Zealand (TSANZ) updated its position statement on corticosteroid use in childhood asthma after reviewing recently published clinical research.

The understanding of childhood asthma and recognition of the need for separate management guidelines for children aged five and under has increased since the TSANZ published its previous position statement in 2002, Professor Peter Van Asperen, Head of the Department of Respiratory Medicine at The Children’s Hospital at Westmead said in an editorial published in the latest Medical Journal of Australia.

“If control is not achieved using initial preventer therapy, it is important to review the diagnosis of asthma – particularly in children aged five years or younger – as many children with recurrent cough are mislabelled as having asthma,” Prof Van Asperen said.

“Oral corticosteroids improve outcomes in children presenting to hospital with acute asthma, but the efficacy of oral corticosteroids for children aged five years or younger with acute, mild-moderate, viral-induced wheezing has been questioned.

“In children aged five years or younger (particularly those with intermittent, viral-induced wheezing) the use of oral corticosteroids should be limited to those with severe wheeze who require hospital admission.”

The revised position statement also provides updated recommendations on the roles of inhaled corticosteroids, leukotriene receptor antagonists and combination medications in childhood asthma management. It highlights the role of leukotriene receptor antagonists as an alternative to long-acting beta-agonists as add on therapy in children not adequately controlled on inhaled corticosteroids and also recommends that long-acting beta-agonists not be used in children aged five years or younger.