Inhaled corticosteroids remain the most effective anti-inflammatory therapy for the treatment of adults and school-aged children with asthma. The efficacy of ICS in preschool children with episodic viral wheeze remains controversial, while ICS treatment of preschool children with multiple-trigger wheeze appears to be at least somewhat effective. However, the effect size in preschool children with multiple-trigger wheeze is smaller than the effect size in school-aged children with asthma.
In school children with asthma, small-particle ICSs, such as ultrafine HFA-BDP and ciclesonide, are as effective as fluticasone propionate on a microgram for microgram basis, and at least as effective, at half the dose, as BUD and CFC-BDP. The small particle ICSs appear to have theoretically a very favourable benefit/risk ratio in preschool children, but prospective clinical studies with these ICS in this age group are needed. ICS are generally well tolerated in both school-aged and preschool children, and adverse events tend to be minimal in both age groups when the ICS is used in appropriate doses.