Efficacy of a short course of parent-initiated oral prednisolone for viral wheeze in children aged 1–5 years: randomised controlled trial

• Published in: The Lancet (British edition) Vol. 362; no. 9394; pp. 1433 - 1438
• Main Authors: Oommen, Abraham, Lambert, Paul C, Grigg, Jonathan
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.11.2003; Lancet; Elsevier Limited
• Subjects: Administration, Oral; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - therapeutic use; Age; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - therapeutic use; Asthma; Asthma - diagnosis; Asthma - drug therapy; Biological and medical sciences; Blood Proteins; Child; Child, Preschool; Children; Children & youth; Circadian Rhythm; Clinical trials; Colds; Common Cold - blood; Common Cold - diagnosis; Common Cold - drug therapy; Corticoids; Daytime; Double-Blind Method; Drug Administration Schedule; Drug therapy; Eosinophil cationic protein; Eosinophil Granule Proteins; Eosinophil-Derived Neurotoxin; Eosinophils - immunology; Evidence-based medicine; Families & family life; Humans; Infant; Leukocyte Count; Medical Records; Medical sciences; Night; Parents & parenting; Pediatrics; Pharmacology. Drug treatments; Prednisolone; Prednisolone - administration & dosage; Prednisolone - therapeutic use; Preschool children; Priming; Protein X; Proteins; Randomization; Respiratory diseases; Respiratory Sounds - drug effects; Respiratory system; Ribonucleases - blood; Risk factors; Stratigraphy; Treatment Outcome; Viruses; United Kingdom > UK; Antineoplastic agent; Human; Preschool age; Corticosteroid; Prognosis; Respiratory disease; Treatment efficiency; Antiinflammatory agent; Infection; Bronchospasm; Chemotherapy; Randomization; Treatment; Short lasting; Viral disease; Adrenal hormone; Bronchus disease; Immunosuppressive agent; Child; Prednisolone
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(03)14685-5

Episodic wheeze triggered by viral colds is common in children aged between 1 and 5 years (preschool viral wheeze). Most affected children are asymptomatic by age 6 years. Persistence of wheeze is associated with above-average systemic eosinophil priming. Use of parental-initiated oral prednisolone is recommended at the first sign of preschool viral wheeze. However, evidence for this treatment strategy is conflicting. We therefore aimed to assess the efficacy of a short course of oral prednisolone for preschool viral wheeze, with stratification for systemic eosinophil priming. Children aged 1–5 years admitted to hospital with viral wheeze were allocated to either a high-primed or low-primed stratum according to amounts of serum eosinophil cationic protein and eosinophil protein X, and randomised to parent-initiated prednisolone (20 mg one daily for 5 days) or placebo for the next episode. The primary outcomes were the 7-day mean daytime and night-time respiratory symptom scores, which were analysed by mean differences between treatment groups. 108 children were randomised to placebo and 109 to prednisolone. Outcome data were available for 120 (78%) of 153 children who had a further episode of viral wheeze, of whom 51 received prednisolone and 69 placebo. Mean daytime (difference in means −0·01 [−0·22 to 0·20]) and night-time (0·10 [−0·12 to 0·32]) respiratory symptom scores and need for hospital admission did not differ between treatment groups. Within the high-primed (n=59) and low-primed (n=61) strata there was no difference in primary outcome between treatment groups. There is no clear benefit of a short course of parent-initiated oral prednisolone for viral wheeze in children aged 1–5 years even in those with above-average eosinophil priming.