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Prednisolone reduces recurrent wheezing after first rhinovirus wheeze: a 7-year follow-up.

AbstractBACKGROUND:
To better understand the role of human rhinovirus-associated wheeze as a risk factor for childhood recurrent wheezing, a cohort of young children experiencing their first wheezing episode was followed until school age.
METHODS:
All 111 hospitalized wheezing children (median age, 12 months) were initially participated in a randomized, double-blind, placebo-controlled, parallel trial on the efficacy of oral prednisolone. In this 7-yr follow-up, risk factors for recurrent wheezing were analysed, and then, the efficacy of prednisolone was evaluated overall and in pre-specified subgroups post-hoc. The main outcome was time to recurrent wheezing.
RESULTS:
The strongest independent risk factor for recurrent wheezing was rhinovirus detection (hazard ratio 3.54; 95% confidence interval 1.51-8.30) followed by sensitization (3.47; 1.55-8.30, respectively) age <1 yr (2.45; 1.29-4.65) and eczema (2.33; 1.11-4.90). Overall, prednisolone did not prevent recurrent wheezing. In subgroup analysis, prednisolone was associated with less recurrent wheezing in children affected by rhinovirus (0.32; 0.12-0.90, adjusted to sensitization, young age, viral aetiology and parental asthma) and/or with eczema (0.27; 0.08-0.87, adjusted respectively).
CONCLUSIONS:
Our data strengthen the role of rhinovirus-associated wheeze as an important risk factor for recurrent wheezing and asthma in young first-time wheezing children. Prospective randomized trials on the efficacy of corticosteroids in rhinovirus-associated early wheezing are warranted. (ClinicalTrials.gov number, NCT 00494624).
AuthorsMinna Lukkarinen, Heikki Lukkarinen, Pasi Lehtinen, Tytti Vuorinen, Olli Ruuskanen, Tuomas Jartti
JournalPediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (Pediatr Allergy Immunol) Vol. 24 Issue 3 Pg. 237-43 (May 2013) ISSN: 1399-3038 [Electronic] England
PMID23373881 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Copyright© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.
Chemical References
  • Glucocorticoids
  • Prednisolone
Topics
  • Administration, Oral
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Glucocorticoids (administration & dosage)
  • Humans
  • Infant
  • Male
  • Picornaviridae Infections (complications)
  • Prednisolone (administration & dosage)
  • Recurrence
  • Respiratory Sounds (drug effects, etiology)
  • Rhinovirus (drug effects)
  • Risk
  • Treatment Outcome

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