| Abstract | BACKGROUND: Rhinovirus-induced early wheezing has been suggested as a new important risk factor for recurrent wheezing. OBJECTIVE: We sought to investigate the risk factors for recurrent wheezing and to determine post hoc the efficacy of prednisolone in risk groups. METHODS: We followed for 1 year 118 children (median age, 1.1 years) who had had their first episode of wheezing and had participated in a trial comparing prednisolone with placebo in hospitalized children. Demographics and laboratory data were obtained at study entry. The follow-up outcome was recurrent wheezing (3 physician-confirmed episodes). RESULTS: Recurrent wheezing was diagnosed in 44 (37%) children. Independent risk factors were age < 1 year, atopy, and maternal asthma. The probability of recurrent wheezing was higher in rhinovirus than respiratory syncytial virus (RSV)-affected children among placebo recipients (hazard ratio, 5.05; 95% CI, 1.00-25.41). Prednisolone decreased the probability of recurrent wheezing in children with eczema (0.15; 95% CI, 0.04-0.63) but not in those without eczema (1.89; 95% CI, 0.83-4.29; P = .007 for interaction). Prednisolone was associated with less recurrent wheezing in the rhinovirus group (0.19; 95% CI, 0.05-0.71), but not in the RSV (2.12; 95% CI, 0.46-9.76) or in the RSV/rhinovirus-negative groups (2.03; 95% CI, 0.83-5.00; P = .017 for interaction). CONCLUSION: Rhinovirus-induced early wheezing is a major viral risk factor for recurrent wheezing. Prednisolone may prevent recurrent wheezing in rhinovirus-affected first-time wheezers. The presence of eczema may also influence the response to prednisolone. CLINICAL IMPLICATIONS: A prospective trial is needed to test the hypothesis that prednisolone reduces recurrent wheezing in rhinovirus-affected wheezing children. |
| Authors | Pasi Lehtinen, Aino Ruohola, Timo Vanto, Tytti Vuorinen, Olli Ruuskanen, Tuomas Jartti
(Affiliation: Department of Pediatrics, Turku University Hospital, Finland.)
|
| Journal | The Journal of allergy and clinical immunology
(J Allergy Clin Immunol)
Vol. 119
Issue 3
Pg. 570-5
(Mar 2007)
ISSN: 0091-6749 United States |
| PMID | 17196244
(Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
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| Chemical References |
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| Topics |
- Child, Preschool
- Cohort Studies
- Eczema
(complications)
- Female
- Follow-Up Studies
- Humans
- Infant
- Male
- Picornaviridae Infections
(complications)
- Placebos
- Prednisolone
(therapeutic use)
- Recurrence
(prevention & control)
- Respiratory Sounds
(drug effects, etiology)
- Rhinovirus
- Treatment Outcome
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