Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Volume 135, Issue 3, Pages 691-U178Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2014.07.001
Keywords
Bronchiolitis; child; corticosteroid; glucocorticoid; treatment; prednisolone; rhinovirus; virus; wheeze; wheezing
Categories
Funding
- Suomen Akatemia Helsinki, Finland [132595, 114034]
- Finnish Medical Foundation, Helsinki, Finland
- Sigrid Juselius Foundation, Helsinki, Finland
- Foundation for Pediatric Research, Helsinki, Finland
- Suomen Kulttuurirahasto, Turku and Helsinki, Finland
- Turku University Foundation, Turku, Finland
- Paulo Foundation, Helsinki, Finland
- Allergy Research Foundation, Helsinki, Finland
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Background: Rhinovirus-induced wheezing is an important risk factor for recurrent wheezing. There are no randomized controlled trials on the effect of systemic corticosteroids in patients with this disease. Objective: We sought to study the short-and long-term effects of prednisolone treatment of the first acute, moderate-to-severe, rhinovirus-induced wheezing episode in young children. Methods: After confirming rhinovirus from nasopharyngeal aspirate by using PCR, 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/d in 2 divided doses for 3 days) or placebo. The trial was double blind throughout the 12-month follow-up. The primary outcomes were long term: new physician-confirmed wheezing episode within 2 months, number of physician-confirmed wheezing episodes within 12 months, and initiation of regular controller medication for asthma symptoms within 12 months. The primary interaction analysis examined rhinovirus load. Results: Seventy-four patients completed the study (mean age, 13 months; 28% atopic). Long-term outcomes did not differ between groups (all P >= .30). For short-term outcomes, the prednisolone group had less cough, rhinitis, noisy breathing, severe breathing difficulties, and nocturnal respiratory symptoms at home within 2 weeks (all P <.05). The 25 children with greater than 7000 rhinovirus copies/mL (most sensitive cutoff) benefitted from prednisolone in terms of less risk of physician-confirmed recurrence within 2 and 12 months compared with placebo (both P <.05). Conclusions: 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.
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