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Efficacy of inhaled salbutamol with and without prednisolone for first acute rhinovirus‐induced wheezing episode
Author(s) -
Hurme Pekka,
Homil Kiara,
Lehtinen Pasi,
Turunen Riitta,
Vahlberg Tero,
Vuorinen Tytti,
Camargo Carlos A.,
Gern James E.,
Jartti Tuomas
Publication year - 2021
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.13960
Subject(s) - salbutamol , medicine , placebo , prednisolone , asthma , corticosteroid , bronchodilator , rhinovirus , anesthesia , randomized controlled trial , pediatrics , respiratory system , alternative medicine , pathology
Background Acute rhinovirus‐induced wheezing is common in young children and may respond to systemic corticosteroid. There are no trials on the efficacy of inhaled beta 2 ‐agonist in this clinical scenario. Objective To study post hoc the short‐term (up to 2 months) efficacy of inhaled beta 2 ‐agonist with and without oral corticosteroid in the first acute rhinovirus‐induced severe wheezing episode in young hospitalized children. Methods The study population came from two randomized controlled trials comparing oral prednisolone (2 mg/kg/d for 3 days) to placebo: Vinku ( n = 35, NCT00494624) used high‐dose regular nebulized salbutamol (0.15 mg/kg 2–4 h intervals) and Vinku2 ( n = 60, NCT00731575, EudraCT 2006‐007100‐42) used inhaled salbutamol on‐demand. Both studies used identical detailed follow‐up assessments. The primary outcome of the former was the duration of hospitalization and of the latter the occurrence of and the time to a new physician‐confirmed wheezing episode within 2 months after discharge. Treatment groups included salbutamol high‐dose vs. salbutamol on‐demand while adjusting for prednisolone status and acknowledging for interactions with exception of the duration of hospitalization in which prednisolone groups could not be fully used due to protocol differences. Results Median age of subjects was 13 months, 32% were sensitized and 22% had doctor‐diagnosed eczema. In the duration of hospitalization, salbutamol high‐dose/placebo versus salbutamol on‐demand/placebo groups did not differ ( p = .12). In the occurrence of and time to relapse within 2 months, a significant group × treatment interaction was observed (both p = .02), such that high‐dose group had less and longer time to relapses than on‐demand group in prednisolone arm (both p < .05), but no difference was detected in placebo arm (both p > .26). Conclusions In young, hospitalized children with first episode of rhinovirus‐induced wheezing, high‐dose inhaled salbutamol may interact with oral prednisolone. However, further trials are warranted.