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Short- and long-term efficacy of prednisolone for first acute rhinovirus-induced wheezing episode.

AbstractBACKGROUND:
Rhinovirus-induced wheezing is an important risk factor for recurrent wheezing. There are no randomized controlled trials on the effect of systemic corticosteroids in patients with this disease.
OBJECTIVE:
We sought to study the short- and long-term effects of prednisolone treatment of the first acute, moderate-to-severe, rhinovirus-induced wheezing episode in young children.
METHODS:
After confirming rhinovirus from nasopharyngeal aspirate by using PCR, 79 children with a first wheezing episode at age 3 to 23 months were randomized to receive oral prednisolone (first dose of 2 mg/kg, followed by 2 mg/kg/d in 2 divided doses for 3 days) or placebo. The trial was double blind throughout the 12-month follow-up. The primary outcomes were long term: new physician-confirmed wheezing episode within 2 months, number of physician-confirmed wheezing episodes within 12 months, and initiation of regular controller medication for asthma symptoms within 12 months. The primary interaction analysis examined rhinovirus load.
RESULTS:
Seventy-four patients completed the study (mean age, 13 months; 28% atopic). Long-term outcomes did not differ between groups (all P ≥ .30). For short-term outcomes, the prednisolone group had less cough, rhinitis, noisy breathing, severe breathing difficulties, and nocturnal respiratory symptoms at home within 2 weeks (all P < .05). The 25 children with greater than 7000 rhinovirus copies/mL (most sensitive cutoff) benefitted from prednisolone in terms of less risk of physician-confirmed recurrence within 2 and 12 months compared with placebo (both P < .05).
CONCLUSIONS:
Prednisolone cannot be routinely recommended for all young children experiencing their first acute, moderate-to-severe, rhinovirus-induced wheezing episode. Prednisolone might be beneficial in a subgroup of children with high viral loads.
AuthorsTuomas Jartti, Riitta Nieminen, Tytti Vuorinen, Pasi Lehtinen, Tero Vahlberg, James Gern, Carlos A Camargo Jr, Olli Ruuskanen
JournalThe Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 135 Issue 3 Pg. 691-8.e9 (Mar 2015) ISSN: 1097-6825 [Electronic] United States
PMID25129681 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Anti-Inflammatory Agents
  • Prednisolone
Topics
  • Acute Disease
  • Anti-Inflammatory Agents (therapeutic use)
  • Double-Blind Method
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Picornaviridae Infections (drug therapy, physiopathology, virology)
  • Prednisolone (therapeutic use)
  • Respiratory Sounds (drug effects, physiopathology)
  • Rhinovirus (physiology)
  • Severity of Illness Index
  • Viral Load

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