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Efficacy of prednisolone in children hospitalized for recurrent wheezing
Author(s) -
Jartti Tuomas,
Lehtinen Pasi,
Vanto Timo,
Vuorinen Tytti,
Hartiala Jaakko,
Hiekkanen Heikki,
Malmberg Pekka,
Mäkelä Mika,
Ruuskanen Olli
Publication year - 2007
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/j.1399-3038.2007.00512.x
Subject(s) - medicine , prednisolone , rhinovirus , placebo , asthma , clinical endpoint , bronchiolitis , pediatrics , randomized controlled trial , respiratory system , alternative medicine , pathology
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 (≥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.