SELECTED ARTICLES FROM THE RECENT LITERATURE 2003

12/15/03

Short course steroid therapy for viral associated wheezing in young children

Summary
Wheezing associated with viral URI is quite common in young children. Some authors have recommended use of a parental initiated short course of oral steroids at the onset of wheezing associated with a viral URI in children 1-5 years old. However, the evidence to support this approach has been conflicting. Oommen et al of the Univ. of Leicester in the UK admitted as in-patients with viral URI associated wheezing (VURI/wheeze) had serum studied for levels of eosinophil proteins (ECP, eosinophil protein X) and were then randomized to receive either a parent- initiated course of 1) prednisolone (20 mg) in 109 children or 2) placebo in 108 children, each given once daily for 5 days during the next VURI/wheeze episode. In 153 of the children who had a further VURI/wheeze episode, there were no significant differences in the mean total and night time respiratory symptoms scores between the steroid-treated and placebo-treated groups. The need for hospitalization also did not differ in the treatment and control groups. There was no difference in response to steroid therapy in those with vs without evidence of eosinophil activation during the preceding wheezing episode.

Reference
Lancet 2003; 362:1433-8

Editor's Comments
Virus URI associated wheezing early in childhood (particularly RSV infection- associated wheezing). Has been reported to be a risk factor for development of persistent asthma later in childhood and in adulthood as well However, several previous reports have concluded that the wheezing and respiratory distress seen in bronchiolitis in infancy (much of which appears to be due to RSV infection) is not helped by systemic corticosteroid treatment. The findings described above support the contention that most cases of VURI/wheeze in early childhood are not helped by corticosteroids. Most of such children no longer wheeze by age 6 years.

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