PURPOSE OF THE STUDY.
Rhinovirus is prevalent in children during the first 2 years of life. Rhinovirus-related cause of early wheezing is strongly associated with recurrent wheezing and asthma. This study hypothesized that prednisolone decreases the risk of relapse in children with their first rhinovirus-induced wheezing episode.
The study included children aged 3 to 23 months, gestational age ≥36 weeks, without previous corticosteroid use who were diagnosed with rhinovirus as detected by polymerase chain reaction and were experiencing their first wheezing episode.
A double-blind randomized control trial design was used; 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/day in 2 divided doses for 3 days) versus placebo. Scheduled follow-up visits were arranged at 2 weeks, 2 months, and 12 months. The 3 primary outcomes were the occurrence of a new physician-confirmed wheezing episode during the 2-month follow-up, the number of physician-confirmed wheezing episodes during the 12-month follow-up, and the initiation of regular controller medication for asthma symptoms during the 12-month follow-up. The primary interaction analysis examined rhinovirus load.
Seventy-four patients completed the study. The prednisolone and placebo groups did not differ for the 3 primary outcomes. However, the 25 children with >7000 rhinovirus copies/mL benefitted from prednisolone in terms of less risk of physician-confirmed recurrence of wheezing within 2 and 12 months compared with placebo (both Ps < .05). For short-term outcomes, the prednisolone group had less cough, rhinitis, noisy breathing, severe breathing difficulties, and nocturnal respiratory symptoms within 2 weeks (all Ps < .05).
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 and lead to a lower risk of relapse or physician-confirmed wheezing episodes within 12 months.
Although prednisolone showed no overall effect on the primary outcomes, the prednisolone group appeared to have benefitted from less short-term symptoms, and, when looking at longer-term outcomes, prednisolone made a difference for those with high rhinovirus loads. A rhinovirus-related cause of early wheezing is a promising new marker for the children at high-risk of asthma, and there is a need for a bedside quantitative rhinovirus detection test. These findings support a role for high rhinovirus load as an important marker in those children with early pulmonary inflammation who might benefit from acute treatment with prednisolone.
- Copyright © 2015 by the American Academy of Pediatrics