NEJM~Prednisolone~Preschool Children~Acute Virus-Induced Wheezing~Not Recommend

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Oral Prednisolone for Preschool Children with Acute Virus-Induced Wheezing

Jayachandran Panickar, M.D., M.R.C.P.C.H., Lakhanpaul, M.D.,

F.R.C.P.C.H., C. Lambert, Ph.D., Priti Kenia, M.B., B.S., M.R.C.P.C.H.,

Terence

son, D.M., F.R.C.P.C.H., Alan Smyth, M.D., F.R.C.P.C.H., and

Grigg, M.D., F.R.C.P.C.H.

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ABSTRACT

Background Attacks of wheezing induced by upper respiratory viral infections

are common in preschool children between the ages of 10 months and 6 years.

A short course of oral prednisolone is widely used to treat preschool

children with wheezing who present to a hospital, but there is conflicting

evidence

regarding its efficacy in this age group.

Methods We conducted a randomized, double-blind, placebo-controlled trial

comparing a 5-day course of oral prednisolone (10 mg once a day for children 10

to 24 months of age and 20 mg once a day for older children) with placebo in

700 children between the ages of 10 months and 60 months. The children presented

to three hospitals in England with an attack of wheezing associated with a

viral infection; 687 children were included in the intention-to-treat analysis

(343 in the prednisolone group and 344 in the placebo group). The primary

outcome was the duration of hospitalization. Secondary outcomes were the score

on the Preschool Respiratory Assessment Measure, albuterol use, and a 7-day

symptom score.

Results There was no significant difference in the duration of

hospitalization between the placebo group and the prednisolone group (13.9

hours vs. 11.0

hours; ratio of geometric means, 0.90; 95% confidence interval, 0.77 to 1.05)

or in the interval between hospital admission and signoff for discharge by a

physician. In addition, there was no significant difference between the two

study groups for any of the secondary outcomes or for the number of adverse

events.

Conclusions In preschool children presenting to a hospital with

mild-to-moderate wheezing associated with a viral infection, oral prednisolone

was not

superior to placebo. (Current Controlled Trials number, ISRCTN58363576

_[controlled-trials.com]_

(http://content.nejm.org/cgi/external_ref?access_num=ISRCTN58363576 & link_type=IS\

RCTN) .)

Source Information

From the Division of Child Health (J.P., M.L., P.K.) and the Centre for

Biostatistics and Genetic Epidemiology, Department of Health Sciences (P.C.L.),

University of Leicester, Leicester; the Division of Child Health, University

of Nottingham, University Hospital Queen's Medical Centre, Nottingham (T.S.,

A.S.); and the Centre for Paediatrics, Institute of Cell and Molecular

Science, Barts and the London School of Medicine and Dentistry, Queen

University London, London (J.G.) — all in the United Kingdom.

Address reprint requests to Dr. Grigg at Paediatric Respiratory and

Environmental Medicine, Centre for Paediatrics, Institute of Cell and Molecular

Science, Barts and the London School of Medicine and Dentistry, 4 Newark St.,

London E1 2AT, United Kingdom, or at _j.grigg@..._

(mailto:j.grigg@...) .

_Full Text of this Article_

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This article has been cited by other articles:

* Bush, A. (2009). Practice Imperfect -- Treatment for Wheezing in

Preschoolers. NEJM 360: 409-410 _[Full Text]_

(http://content.nejm.org/cgi/content/full/360/4/409)

* (2009). Treatment for Children with Viral-Induced Wheeze. JWatch

Pediatrics 2009: 1-1 _[Full Text]_

(http://pediatrics.jwatch.org/cgi/content/full/2009/121/1)

Sharon

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