Table 4—

Treatment of acute pre-school viral wheeze

MedicineQuality of evidenceRecommendationComment
Inhaled short-acting β2-agonistsNo effect on clinically relevant outcomes (high), but improvement of lung function (moderate)Inhaled short-acting β2-agonists should be usedGrading applies to children aged <2 yrsRCT in older children with acute viral wheeze unlikely to be done for ethical reasons
Intravenous short-acting β2-agonistsNo studies in acutely wheezy pre-school children (very low)Intravenous short-acting β2-agonists should not be usedNo studies in acutely wheezy pre-school children
Inhaled epinephrineSome evidence of short-term favourable effects (moderate)Inhaled epinephrine should be used for in-hospital treatmentStudies in mixed populations with acute viral wheeze and bronchiolitisNo studies in older pre-school children in outpatients
Inhaled high-dose corticosteroids (short course)Modest effect on clinical outcomes, when started at the onset of the acute episode or at the onset of a cold (moderate)High-dose intermittent inhaled corticosteroids should probably be used on a case-by-case basis, especially in children with a positive asthma predictive indexThe dose and duration of treatment required to achieve similar outcomes remain to be clarified
Systemic corticosteroidsConflicting data on the effectiveness of early administration of corticosteroids on clinical parameters (high)Systemic corticosteroids should probably not be used for the majority of children, and reserved for severe wheezeDespite the high quality of the trials, there is a marked clinical heterogeneity of benefits
Leukotriene receptor antagonistsReduction of severity of acute illnesses (moderate)Montelukast should probably be used intermittently on a case-by-case basis in children with positive asthma predictive indexHeterogeneity of the included phenotypes
  • RCT: randomised controlled trial.