ORAL PREDNISOLONE IN THE ACUTE MANAGEMENT OF CHILDREN AGE 6 TO 35 MONTHS WITH VIRAL RESPIRATORY INFECTION-INDUCED LOWER AIRWAY DISEASE: A RANDOMIZED, PLACEBO-CONTROLLED TRIAL
Csonka P, Kaila M, Laippala P, et al. J Pediatr. 2003;143:725–730
Purpose of the Study.
Systemic corticosteroid use for the treatment of acute wheezing among preschool-aged children is controversial, with a recent meta-analysis finding only marginal positive effects with orally administered corticosteroids among children <24 months of age. The objective of this study was to investigate the efficacy of oral prednisolone treatment of virally induced lower respiratory disease among young children.
The clinical population included 230 children, 6 to 35 months of age, who presented with virally induced lower respiratory disease. Children with previous asthma or ≥2 wheezing episodes were excluded.
The study was a randomized, double-blind, placebo-controlled trial involving treatment with orally administered prednisone (2 mg/kg per day) or placebo for 3 days. Measured outcomes included the effects of treatment on symptoms, hospital length of stay, and duration of illness.
Hospitalization rates were similar for the 2 groups. However, for admitted children (n = 123), the median length of stay was 1 day shorter in the prednisolone group (2 days vs 3 days, P = .060). The proportions of children who required ≥3 days of hospitalization were 48% in the prednisolone group and 68% in the placebo group (P = .023). There was also a reduction in the need for additional asthma medication (18.0% vs 37.1%, P = .018) in the prednisolone group. The mean duration of symptoms of respiratory distress was 1 day in the prednisolone group, compared with 2 days in the placebo group, for both the hospitalized (P < .001) and nonhospitalized (P = .006) children.
A 3-day course of oral prednisolone therapy effectively reduced disease severity, length of hospital stay, and duration of symptoms among children, 6 to 35 months of age, with virally induced lower respiratory disease.
This study is reassuring, indicating that the common practice of using orally administered corticosteroids in the treatment of infants and toddlers with lower respiratory infections seems to be effective, even among first-time wheezers.