Controller medication for wheezing in infancy

Abstract

Recurrent wheeze in infants and young children arises from heterogenous pathophysiology and "endotypes" are still unknown. Currently, phenotyping of the disease has been employed to identify optimal treatment options or to predict outcomes of wheezing. We performed 2 clinical studies on treatment options. First, we tried to prove beneficial outcome by recommendation of Japanese Pediatric Guideline for the treatment and management of asthma (JPGL) compared with that of the international guideline, Global Initiative for Asthma (GINA). For mild asthma JPGL recommends controller treatment with leukotriene receptor antagonists, whereas GINA recommends no controllers. The 2 options were compared in the randomized controlled study and we found that asthma exacerbation rate in JPGL group was significantly lower than in GINA group. Second, we compared clinical effect of inhaled corticosteroid, budesonide, and montelukast in a biomarker-defined phenotype of recurrent wheeze in preschool children. The biomarkers were house dust mite sensitization and an eosinophil marker, EDN. However, we did not find any difference in the clinical effect in the "atopic asthma" type group. Recent clinical studies of early treatment for wheezing children are also reviewed.