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Short- and long-term efficacy of prednisolone for first acute rhinovirus-induced wheezing episode.


ABSTRACT:

Background

Rhinovirus-induced wheezing is an important risk factor for recurrent wheezing. There are no randomized controlled trials on the effect of systemic corticosteroids in patients with this disease.

Objective

We sought to study the short- and long-term effects of prednisolone treatment of the first acute, moderate-to-severe, rhinovirus-induced wheezing episode in young children.

Methods

After confirming rhinovirus from nasopharyngeal aspirate by using PCR, 79 children with a first wheezing episode at age 3 to 23 months were randomized to receive oral prednisolone (first dose of 2 mg/kg, followed by 2 mg/kg/d in 2 divided doses for 3 days) or placebo. The trial was double blind throughout the 12-month follow-up. The primary outcomes were long term: new physician-confirmed wheezing episode within 2 months, number of physician-confirmed wheezing episodes within 12 months, and initiation of regular controller medication for asthma symptoms within 12 months. The primary interaction analysis examined rhinovirus load.

Results

Seventy-four patients completed the study (mean age, 13 months; 28% atopic). Long-term outcomes did not differ between groups (all P ≥ .30). For short-term outcomes, the prednisolone group had less cough, rhinitis, noisy breathing, severe breathing difficulties, and nocturnal respiratory symptoms at home within 2 weeks (all P < .05). The 25 children with greater than 7000 rhinovirus copies/mL (most sensitive cutoff) benefitted from prednisolone in terms of less risk of physician-confirmed recurrence within 2 and 12 months compared with placebo (both P < .05).

Conclusions

Prednisolone cannot be routinely recommended for all young children experiencing their first acute, moderate-to-severe, rhinovirus-induced wheezing episode. Prednisolone might be beneficial in a subgroup of children with high viral loads.

SUBMITTER: Jartti T 

PROVIDER: S-EPMC7112325 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Short- and long-term efficacy of prednisolone for first acute rhinovirus-induced wheezing episode.

Jartti Tuomas T   Nieminen Riitta R   Vuorinen Tytti T   Lehtinen Pasi P   Vahlberg Tero T   Gern James J   Camargo Carlos A CA   Ruuskanen Olli O  

The Journal of allergy and clinical immunology 20140813 3


<h4>Background</h4>Rhinovirus-induced wheezing is an important risk factor for recurrent wheezing. There are no randomized controlled trials on the effect of systemic corticosteroids in patients with this disease.<h4>Objective</h4>We sought to study the short- and long-term effects of prednisolone treatment of the first acute, moderate-to-severe, rhinovirus-induced wheezing episode in young children.<h4>Methods</h4>After confirming rhinovirus from nasopharyngeal aspirate by using PCR, 79 childre  ...[more]

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