Episodic viral wheeze in preschool children: effect of topical nasal corticosteroid prophylaxis

Background: The effect of prophylactic nasal corticosteroids on wheezing episodes associated with colds was investigated in a 12 week parallel group, double blind, randomised controlled trial in preschool children. Methods: Data were collected from 50 children aged 12 - 54 months with a history of at least three episodes of wheeze associated with colds over the previous winter, but few or no interval symptoms; 24 were given one dose of fluticasone aqueous nasal spray (50 mug) into each nostril twice daily and 26 received an indistinguishable placebo spray. Episodes of lower respiratory illness occurring within 2 days of the onset of a cold were identified from daily symptom diaries. The main outcome was nocturnal symptom score during the first 7 days of an episode. Results: The groups were well balanced on entry except that the treatment group had a history of more prolonged episodes. During the trial there was no significant difference in the number of episodes in the treatment and control groups ( 27 and 37, respectively), in the severity of nocturnal symptoms ( mean score 1.33 and 1.22, respectively, confidence interval of difference - 0.24 to + 0.47) or in daytime symptoms, activity or total scores during episodes. Compliance was estimated to be over 50% in 43 of the children. Conclusions: Nasal corticosteroid treatment does not prevent acute wheezy episodes associated with upper respiratory infections ( common colds) in preschool children.