Prednisolone for preschool, virus-induced wheezing
Virus-induced wheezing in preschool children is common and distinct from asthma. Guidelines from the United States recommend a course of oral steroid for such children who present to hospital with an acute episode, but the evidence for this treatment is questionable. Now a study at three UK hospitals has shown no benefit from oral prednisolone.
A total of 700 children aged 10–60 months presenting to hospital with virus-induced wheezing were randomized to oral prednisolone (10 mg once daily at age 10–24 months and 20 mg once daily for older children) or placebo for 5 days. Virus-induced wheezing was defined as wheezing preceded by a viral upper respiratory infection diagnosed by a doctor on clinical grounds. The duration of hospital stay was similar in the two groups (11 hours in the prednisolone group versus 14 hours in the placebo group, a non-significant difference). There were no significant group differences in wheezing severity, use of albuterol (salbutamol) or 7-day symptom score.
A course of prednisolone did not benefit these children.
Panickar J, et al. Oral prednisolone for preschool children with acute virus-induced wheezing. NEJM 2009;360:329–338; Bush A. Practice imperfect—treatment for wheezing in preschoolers. Ibid:409–410 (editorial).