Prednisolone for the first rhinovirus-induced wheezing and 4-year asthma risk: A randomized trial.

Abstract

BACKGROUND:

Previous findings show that corticosteroid treatment during the first acute wheezing episode may reduce recurrent wheezing in children with high rhinovirus genome load at 12-month follow-up. Longer-term effects have not been investigated prospectively.

METHODS:

After PCR confirmation of rhinovirus from nasopharyngeal aspirate, 79 children with the first acute wheezing episode were randomized to receive orally prednisolone or placebo for 3 days. The initiation of asthma control medication before the age of 5 years was confirmed from medical record and/or from parental interview. The outcome was the time to initiation of regular asthma control medication. Interaction analysis examined rhinovirus genome load.

RESULTS:

Fifty-nine (75%) children completed the follow-up. Asthma control medication was initiated in 40 (68%) children at the median age of 20 months. Overall, prednisolone did not affect the time to initiation of asthma control medication when compared to placebo (P=.99). Rhinovirus load modified the effect of prednisolone regarding the time to initiation of asthma control medication (P-value for interaction=.04). In children with high rhinovirus load (>7000 copies/mL; n=23), the risk for initiation of medication was lower in the prednisolone group compared to the placebo group (P=.05). In the placebo group, asthma medication was initiated to all children with high rhinovirus load (n=9) during the 14 months after the first wheezing episode.

CONCLUSIONS:

Overall, prednisolone did not affect the time to initiation of asthma control medication when compared to placebo. However, prednisolone may be beneficial in first-time wheezing children whose episode was severe and associated with high rhinovirus load. (ClinicalTrials.gov, NCT00731575).

• Authors: Annamari Koistinen, Minna Lukkarinen, Riitta Turunen, Tytti Vuorinen, Tero Vahlberg, Carlos A Camargo Jr, James Gern, Olli Ruuskanen, Tuomas Jartti
• Journal: Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (Pediatr Allergy Immunol) Vol. 28 Issue 6 Pg. 557-563 (Sep 2017) ISSN: 1399-3038 [Electronic] England
• PMID: 28660720 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Chemical References

• Anti-Asthmatic Agents
• Anti-Inflammatory Agents
• Prednisolone

Topics

• Administration, Oral
• Anti-Asthmatic Agents (therapeutic use)
• Anti-Inflammatory Agents (therapeutic use)
• Asthma (drug therapy, prevention & control, virology)
• Child, Preschool
• Double-Blind Method
• Drug Administration Schedule
• Female
• Follow-Up Studies
• Humans
• Infant
• Male
• Picornaviridae Infections (complications, drug therapy, virology)
• Prednisolone (therapeutic use)
• Prospective Studies
• Respiratory Sounds (etiology)
• Rhinovirus
• Severity of Illness Index
• Treatment Outcome
• Viral Load