Oral prednisolone in preschool children with virus-associated wheeze: a prospective, randomised, double-blind, placebo-controlled trial
SJ Foster, MN Cooper, S Oosterhof, ML Borland
Lancet Respir Med 2018;6:97–106
One in three children under the age of three years will experience an episode of wheeze, with viruses assumed to be the triggering factor. The clinical course of wheeze in pre-school children is different to that of asthma in adolescents and adults, for whom a beneficial role of corticosteroid administration in reducing the need for hospital admission during asthma episodes has been shown. This evidence is more robust than that supporting corticosteroid use in paediatric wheeze exacerbations.
Meredith Borland and colleagues from Perth, Australia, have run a prospective, randomised, double-blind, placebo-controlled trial to assess the efficacy of oral prednisolone in children presenting to a paediatric emergency department with suspected virus-associated wheeze. Six hundred and twenty-four patients aged between two and six years were randomly assigned to a three-day course of either oral prednisolone or placebo once daily.
Analysis of the study’s primary hypotheses showed that placebo treatment was inferior to prednisolone in reducing the length of stay in hospital in these children. The greatest efficacy was seen in patients with either severe features of wheeze at presentation, receiving salbutamol before presentation or prior history of asthma. No other significant predictors were found.