Panickar J, Lakhanpaul M, Lambert PC, et al. N Engl J Med. 2009;360(4):329–338
PURPOSE OF THE STUDY. To determine the efficacy of a short course of oral prednisolone treatment for wheezing induced by upper respiratory viral infections in preschool-aged children.
STUDY POPULATION. The study included 700 children between 10 and 60 months of age who were hospitalized at 3 different centers in England with attacks of wheezing associated, by the judgment of an examining physician, with viral infection. Most of these patients did not have the classic phenotype of atopic asthma.
METHODS. This was a randomized, double-blind, placebo-controlled trial. In the nonplacebo arm of the study, children 10 to 24 months of age received 5 days of prednisolone treatment at 10 mg/day, whereas the older children received 20 mg/day. The primary outcome was duration of hospitalization. Secondary outcomes were Preschool Respiratory Assessment Measure scores, use of albuterol, and 7-day symptom scores.
RESULTS. There was no significant difference in the duration of hospitalization between the placebo group and the prednisolone group (13.9 vs 11.0 hours) or in the interval between hospital admission and signoff for discharge by a physician. There was also no significant difference in any of the secondary outcomes or in the number of adverse events.
CONCLUSIONS. In preschool-aged children presenting to a hospital with mild-to-moderate wheezing associated with a viral infection, oral prednisolone treatment was not superior to placebo.
REVIEWER COMMENTS. I fondly remember my numerous rotations in the emergency department during my residency at St Louis Children's Hospital, when one of my goals was to quickly assess wheezing children and to just as quickly give them oral steroids. This report suggests that we should think twice before giving that oral steroid. However, it must be pointed out that the dose of prednisolone used in the trial was substantially less than 2 mg/kg and the lack of effect may reflect, in part, the dose. Furthermore, most of the patients in this trial did not have atopy. Wheezing children with allergies do respond to oral corticosteroid treatment. This trial does raise very important questions about commonly accepted norms of treatment, but “real-world” practice may be different.
- Copyright © 2009 by the American Academy of Pediatrics