Budesonide in preschool-age children with recurrent wheezing.

Report that early intermittent high-dose inhaled glucocorticoid treatment effectively reduced asthma exacerbations in preschool-age children with wheezing. Applying this strategy in clinical practice poses a problem. In this study and in the previous Acute Intervention Management Strategies (AIMS) study (NCT00000622) by the same CARE Network,1 patients were treated with an inhaled budesonide suspension delivered by means of a nebulizer, which may not reflect its delivery when a similar metered-dose inhaler is used for delivery. International guidelines on asthma management in preschool-age children recommend a metered-dose inhaler with a dedicated spacer and mask as the preferred device for delivering inhaled drugs2; despite this recommendation, nebulizers are widely used.3 With the currently available evidence,1,4 should we consider that the same results would have been obtained if a metered-dose inhaler and spacer, which are more portable than a nebulizer, had been used?