Abstract | BACKGROUND: 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.
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Authors | Tuomas Jartti, Riitta Nieminen, Tytti Vuorinen, Pasi Lehtinen, Tero Vahlberg, James Gern, Carlos A Camargo Jr, Olli Ruuskanen |
Journal | The 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 |
PMID | 25129681
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Anti-Inflammatory Agents
- Prednisolone
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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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