The controversial question of whether preschool children with virus-associated wheeze benefit from oral corticosteroids has been answered by a randomised controlled trial from Western Australia.
Emergency department stays are cut by about three hours when wheezy children are given oral prednisolone, clinicians at the Princess Margaret Hospital, Perth, have shown.
In a study of more than 600 children aged two and five presenting to an emergency department with a presumed virus-associated wheezing episode, the use of oral steroids was associated with a 20% reduction in length of hospital stay (540 vs 370 minutes) compared to placebo.
Children randomised to the active treatment group were given a three day course of prednisolone (1 mg/kg per day). In a post-hoc analysis the likelihood of hospital stay exceeding 12 hours was reduced by one third with steroid treatment (38% for placebo vs 25% for prednisolone)
“The absolute reduction in the percentage of patients with a length of stay exceeding 12 hours (13%) represents a number needed to treat of about eight patients to prevent the length of stay of one patient exceeding 12 hours,” the study authors noted in Lancet Respiratory Medicine.
Benefits of oral steroid were described as “compelling” in children who had severe features of wheeze, had received salbutamol before presentation, or had a prior history of asthma.
The researchers, led by paediatric emergency medicine specialist Dr Meredith Borland, said corticosteroids were currently not recommended in guidelines as first-line therapy for preschool children with wheeze because a previous large study had shown no benefit compared to placebo.
However that study may have been biased because it included children with mild wheeze and did not exclude younger infants, who were likely to have bronchiectasis rather than viral-associated wheeze, she noted.
The new randomised controlled trial showed a clear benefit for oral prednisolone, which “should be administered early in the management of virus-associated wheeze in preschool aged children presenting to the emergency department,” the researchers concluded.