Since this meta-analysis has been performed, a further meta-analysis has been performed comparing the effectiveness of continuous and intermittent high-dose inhaled corticosteroid (ICS), with placebo and montelukast at preventing a severe exacerbation in preschool wheeze . Continuous ICS and intermittent ICS were both found to be effective but were also found to be significantly more effective than montelukast at preventing a severe attack . This meta-analysis illustrated the strong and consistent evidence that ICS is effective in preschool wheeze. This paper, as well as our findings, may influence a change in protocol for the treatment of preschool wheeze. There have also been some early data to suggest that azithromycin therapy in severe preschool wheeze may prevent a severe exacerbation [3, 19], but more work in this area is required, due to the increase in bacterial resistance following such medication.