Efficacy of prednisolone in children hospitalized for recurrent wheezing

Abstract

Data on the efficacy of corticosteroids on respiratory picornavirus-induced wheezing are limited. To determine whether prednisolone is effective in rhinovirus- or enterovirus-induced recurrent wheezing, we conducted a controlled trial comparing oral prednisolone (2 mg/kg/day in three divided doses for 3 days) with placebo in hospitalized wheezing children and studied post hoc virus-specific efficacy in early wheezing (<3 episodes, reported elsewhere) and in recurrent wheezing (>or=3 episodes). Virus-negative children where excluded. Our primary endpoint was the time until children were ready for discharge. Secondary endpoints included oxygen saturation and exhaled nitric oxide during hospitalization, duration of symptoms, blood eosinophil count, and impulse oscillometry 2 wk after discharge, and occurrence of relapses during the following 2 months. Virus-specific effects were analyzed with interaction analysis in a multivariate regression model. During the study period, 661 patients were hospitalized, 293 randomized, and 59 were accepted in this analysis (mean age 2.6 yr, s.d. 1.3). Prednisolone did not significantly decrease the time until ready for discharge in all patients (prednisolone vs. placebo, medians, 18 vs. 24 h, p = 0.11). However, prednisolone decreased the time until ready for discharge in children with picornavirus infection (respectively, 12 vs. 24 h, p = 0.0022) and more specifically, in children with enterovirus infection (6 vs. 35 h, p = 0.0007). In the secondary endpoints, prednisolone decreased the duration of cough and dyspnea in rhinovirus-affected children (p = 0.033 for both). Prospectively designed clinical trial is needed to test the hypothesis that prednisolone reduces symptoms in picornavirus-affected wheezing children.

Oral and inhaled corticoid treatment for wheezing in the first year of life

“…O questionário do EISL, previamente validado para a população brasileira, é constituído por 45 perguntas sobre manifestações do sistema respiratório, aspectos relativos à sibilância, uso de medicações, diagnóstico médico, além de características familiares, ambientais e demográficas relativas aos 12 primeiros meses de vida do lactente 8 . Sibilância recorrente foi definida como maior ou igual a três episódios de sibilância no primeiro ano de vida.…”

“…Em relação aos estudos sobre a utilização de CI para o tratamento da sibilância em lactentes, existem diferenças nos critérios de seleção das crianças, nas estratégias de tratamento, na coleta dos dados e nos desfechos considerados 8,[13][14][15][16][17][18][19][20][21][22][23][24][25] . Apesar disso, é possível concluir que a utilização de CI em lactentes pode, em algumas situações, possibilitar um melhor controle dos sintomas que, porém, não se sustenta após a suspensão do mesmo, ou seja, não interfere A principal limitação do presente estudo compreende o fato de as frequências de uso de CO e CI serem estimadas pelo relato dos pais ou responsáveis pela criança e não através de registros médicos, o que seria mais confiável.…”

Nasopharyngeal bacterial colonization during the first wheezing episode is associated with longer duration of hospitalization and higher risk of relapse in young children

“…The predefined secondary outcomes were clinic visits for recurrent wheezing during a 2-month period after the discharge for all recruited subjects (n=293) and time to recurrent wheezing (i.e. 3 physician confirmed wheezing episodes) within 12 months after discharge for the first-time wheezing children (n=131) (11,16,17). In this observational study, we report the associations between specific findings of bacterial colonization/infections and clinical outcomes of the study.…”

“…a half of the patients were randomized to receive oral prednisolon for 3 days and the other half placebo in a double blind design (first dose 2 mg/kg, then 2 mg/kg/d in 3 divided doses). The methods have been described earlier (7,16,17). The present study included all children of the VINKU study that had their first wheezing episode and age 3 -35 months ( Fig.…”

“…Blood samples were collected at study entry and 2-3 weeks later, and analysed as previously described (11,16,17). Urine samples were collected at study entry.…”