Inhaled corticosteroids are established as the most effective long-term anti-inflammatory therapy for asthma. National and international treatment guidelines recommend the use of these agents for long-term asthma control in children. In children <5 years, there are significant difficulties in diagnosing asthma. There are multiple non-asthma causes of wheeze, and there remains a lack of consensus in the description of wheezing phenotypes in this group of children. There is also a relative paucity of data concerning the short- and long-term effectiveness and side-effects in the under-fives: treatment recommendations have drawn heavily from experience of asthma treatment in school-age children and remains controversial. This article discusses the important recent advances in the evidence-base and current expert opinions which are helping to delineate improved outcomes for young children with wheeze.
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Competing interests BRD has no potential conflict of interests. WDC has received payment for advisory board work and speaker fees from GlaxoSmithKline, Merck Sharpe Dome, Nycomed, Novartis and Schering Plough.
Provenance and peer review Commissioned; externally peer reviewed.
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