Is fluticasone or cilantro effective for treating wheezing?

Fluticasone for Wheezing: Evidence-Based Recommendation

Fluticasone is effective for treating wheezing in children and adults with asthma, but there is no evidence that cilantro has any therapeutic role in respiratory disease. 1

Fluticasone Efficacy by Age and Clinical Context

Children Aged 0-4 Years with Recurrent Wheezing

For young children with recurrent wheezing triggered by respiratory infections, intermittent inhaled corticosteroids (ICS) including fluticasone reduce exacerbations requiring systemic corticosteroids by 33%, but this comes with growth concerns. 1

• The 2020 NAEPP guidelines conditionally recommend intermittent ICS with SABA at the onset of respiratory tract infections for children 0-4 years with recurrent wheezing 1
• Fluticasone 750 μg twice daily for up to 10 days at infection onset showed a 5% lower gain in height and weight, with significant correlation between cumulative dose and height changes 1
• High-dose fluticasone (750 μg twice daily) reduced rescue oral corticosteroid use from 18% to 8% of respiratory infections, but caused smaller gains in height (z-score difference -0.24) and weight (z-score difference -0.26) 2

Critical caveat: Growth monitoring is essential, and treatment should be reconsidered if reduced growth rate occurs that cannot be attributed to other factors 1

Long-Term Prevention in Young Children: Not Recommended

Daily fluticasone for secondary prevention of asthma in wheezy infants does not alter the natural history of asthma or prevent lung function decline. 3

• A large randomized trial (200 children) showed no difference at age 5 years in current wheeze, physician-diagnosed asthma, lung function (FEV1), or airway reactivity between fluticasone and placebo groups 3
• Short-term studies (3-6 months) in infants showed conflicting results: some demonstrated improved forced flows and symptom control 4, 5, while others showed no improvement in lung function or symptoms 6

Children Aged 5-11 Years and Adolescents/Adults with Persistent Asthma

For persistent asthma in patients ≥5 years, daily low-dose ICS (including fluticasone) is the preferred Step 2 controller therapy. 1

• Low-dose fluticasone provides the greatest clinical benefit at 200 μg/day in adolescents and adults with moderate-to-severe asthma, with minimal additional improvement at 500-1000 μg/day 1
• For patients ≥12 years with mild persistent asthma, either daily low-dose ICS with as-needed SABA or as-needed ICS with SABA used concomitantly are conditionally recommended 1

Practical Dosing Recommendations

For Acute Wheezing Episodes (Children 1-6 Years)

• Fluticasone 750 μg twice daily (ex-valve dose) at onset of upper respiratory infection for maximum 10 days reduces need for rescue systemic corticosteroids 2
• Warning: This high-dose intermittent approach should not be adopted in routine clinical practice until long-term adverse effects are clarified 2

For Maintenance Therapy (Persistent Asthma)

• Adults: Start with 200 μg once daily (two 50-μg sprays per nostril) or 100 μg twice daily 7
• Children 4-11 years: Start with 100 μg once daily; reserve 200 μg daily for inadequate responders 7
• Maximum benefit may take several days; some patients experience symptom improvement within 12 hours 7

Safety Monitoring Requirements

All children on fluticasone require growth monitoring, particularly with intermittent high-dose or chronic therapy. 1, 7

• Monitor height velocity at regular intervals 1
• Check for local adverse effects: nasal irritation, epistaxis, rare nasal septum perforation 7
• Examine periodically for Candida infection of nose/pharynx with prolonged use (>several months) 7
• Rare systemic effects include wheezing, cataracts, glaucoma, increased intraocular pressure, and HPA axis suppression 7

Cilantro: No Evidence

There is no scientific evidence supporting cilantro (coriander) for treating wheezing or any respiratory condition. This appears to be a misunderstanding or autocorrect error in the question. All evidence-based treatment for wheezing centers on bronchodilators and anti-inflammatory medications like fluticasone, not herbal remedies.

Clinical Decision Algorithm

1. Identify patient age and wheezing pattern:

   • Intermittent viral-triggered wheezing in children 0-4 years → Consider intermittent ICS at infection onset (conditional recommendation with growth monitoring) 1
   • Persistent asthma symptoms ≥5 years → Daily low-dose ICS as Step 2 therapy 1
   • Mild persistent asthma ≥12 years → Either daily low-dose ICS or as-needed ICS/SABA 1

2. Avoid these pitfalls:

   • Do not use daily ICS for long-term prevention in wheezy infants without established persistent asthma 3
   • Do not exceed recommended doses; higher doses provide minimal additional benefit with increased systemic effects 1
   • Never use long-acting beta-agonists as monotherapy; always combine with ICS 1