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.