A comparison between nebulized terbutaline, nebulized corticosteroid and systemic corticosteroid for acute wheezing in children up to 18 months of age

Daugbjerg, Peer; Brense, E; Forchhammer, H; Frederiksen, Birgitte; Glazowski, MJ; Ibsen, K. Kaas; Knabe, N; Leth, H; Marner, B.; Pedersen, F. K.; Østergaard, Grete

doi:10.1111/j.1651-2227.1993.tb12750.x

Cited by 70 publications

(38 citation statements)

References 14 publications

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“…7,8 Seriously ill infants who required admission to the intensive care unit also were excluded in 2 of the studies. 8,12 Only in 1 study were tests of lung function performed. 9 Some of the studies had a 2-to 4-week follow-up, 7-9 but none had a long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Prednisolone Treatment of Respiratory Syncytial Virus Infection: A Randomized Controlled Trial of 147 Infants

et al. 1999

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ABSTRACT. Objective. To evaluate the effect of systemic prednisolone as an adjunct to conventional treatment with ␤2-agonist, respiratory support, and fluid replacement in hospitalized infants <24 months of age with respiratory syncytial virus (RSV) infection.Methods. The study was randomized, double-blind, and placebo-controlled. During the winter of 1995-1996, 147 infants <2 years of age, hospitalized with RSV infection, were allocated to treatment with either systemic prednisolone mixture 2 mg/kg daily or placebo for 5 days.Main Outcome Measures. The acute effect variables were duration of stay in hospital, use of medicine, and supportive measures while in hospital. At follow-up 1 month after discharge, the acute effect variables were duration of illness, start in day care center, morbidity, and use of medicine. At follow-up 1 year after discharge, the acute effect variables were morbidity, use of medicine, and skin prick tests with allergens.Results. Prednisolone treatment had no effect on any of the outcome measures.Conclusions. Our randomized prospective study in infants hospitalized with acute RSV infection showed no effect of systemic prednisolone treatment either in the acute state of RSV infection, nor in the follow-up 1 month and 1 year after admission to hospital. We find our results in agreement with the largest studies reported earlier; therefore, corticosteroid, whether by the systemic route or by inhalation, should not be prescribed to infants with RSV infection. Pediatrics 1999;104(6). URL: http://www.pediatrics.org/cgi/content/full/104/6/e77; infants, respiratory syncytial virus, prednisolone, corticosteroids, treatment, randomized controlled trial.ABBREVIATIONS. RSV, respiratory syncytial virus; IV, intravenous; CPAP, continuous positive airway pressure. P revious studies have shown that a majority of infants are infected with respiratory syncytial virus (RSV) during their first or second year of life.1 However, only a minority of these children are admitted to hospital. 2Because of many clinical and presumed pathophysiological similarities between RSV infection and asthma, corticosteroid has been used widely for treatment of RSV infections. [3][4][5] Of the reports of randomized, controlled studies of systemic corticosteroid treatment of RSV infection in infants, 7 have shown conflicting results.6 -12 However, these studies are not directly comparable because of the differences of diagnostic criteria, exclusion criteria, and measures of effect.This study investigates the short-term and longterm effects of systemic corticosteroid treatment in a large, unselected group of infants hospitalized with RSV infection. METHODSThe 3 participating pediatric departments serve the County of Copenhagen and 1 neighboring county with a joint population of ϳ34 000 infants Ͻ2 years of age. A total of 147 hospitalized infants were included prospectively between November 1995 and April 1996. Inclusion CriteriaPatients Ͻ2 years of age hospitalized with respiratory infection and a positive RSV test were included i...

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Section: Discussionmentioning

confidence: 99%

Prednisolone Treatment of Respiratory Syncytial Virus Infection: A Randomized Controlled Trial of 147 Infants

et al. 1999

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“…Inhaled budesonide improves symptoms in wheezy infants with moderate to severe disease [6, 7, 8, 9, 10, 11, 12]. Gibson et al [13]showed that symptom scores may be more sensitive to deterioration than lung function measurements in many patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Subjective and Objective Measures in Recurrently Wheezy Infants

Wildhaber

Dore²,

Devadason³

et al. 2002

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Objectives: The aim of this study was to compare subjective measures (overall health assessment both by the study physician and the child’s mother) with objective measurements of forced expiratory volumes (FEV_t) and maximal flow at functional residual capacity v̇_maxFRC) in recurrently wheezy infants. Methods: Sixteen wheezy infants (12 boys) aged 8–26 months were studied. A clinical assessment at visit 1 was followed by the run-in period during which day- and nighttime asthma symptom scores were obtained. The actual study period consisted of 2 visits when patient’s lung function was assessed. The first of which was during an acute exacerbation (visit 2), while the second was when the infant was asymptomatic (visit 3). FEV_t were obtained by the raised volume rapid thoracic compression technique (RVRTC) and v̇_maxFRC by the tidal volume rapid thoracic compression technique (TVRTC). Results: Mean FEV_t but not mean v̇_maxFRC were significantly lower at visit 2 compared to visit 3 (FEV_0.5: p = 0.005, and FEV_0.75: p = 0.002; v̇_maxFRC: p = 0.15) and correlated well with overall health assessment by the study physician (FEV_0.5: r = 0.82, and FEV_0.75: r = 0.84), but not with the overall health assessment by the mother. Conclusions: We have shown in the present study that objective measurements of FEV_t from a raised lung volume correlate well with the overall health assessment by the study physician; this was in contrast to measurements of v̇_maxFRC in the tidal volume range. We therefore conclude that the RVRTC technique is a feasible method to assess and monitor obstructive lung disease in infancy.

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“…However, others have found significant improvement in terms of lung function [16], clinical scores and the number of days of hospital admission [1,3,4,6,8,13]. Controversy still remains, therefore, over the correct use of inhaled ~32 agonists in this clinical situation.…”

Section: Introductionmentioning

confidence: 89%

Treatment of recurrent acute wheezing episodes in infancy with oral salbutamol and prednisolone

1996

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A comparison between nebulized terbutaline, nebulized corticosteroid and systemic corticosteroid for acute wheezing in children up to 18 months of age

Cited by 70 publications

References 14 publications

Prednisolone Treatment of Respiratory Syncytial Virus Infection: A Randomized Controlled Trial of 147 Infants

Prednisolone Treatment of Respiratory Syncytial Virus Infection: A Randomized Controlled Trial of 147 Infants

Comparison of Subjective and Objective Measures in Recurrently Wheezy Infants

Treatment of recurrent acute wheezing episodes in infancy with oral salbutamol and prednisolone

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