Oral corticosteroids can significantly improve short-term outcomes in pre-school children with acute wheeze, with the greatest benefit seen in those with moderate to severe wheeze, previous wheeze, or asthma, a meta-analysis has shown.

The data revealed a significant impact on wheeze severity and length of hospital stay. Also, reassuringly, there were infrequent reports of adverse events, although oral corticosteroids were linked with a higher risk of vomiting, a group of international researchers noted, in a paper published in The Lancet Respiratory Medicine (link here).

The team, led by Dr Bohee Lee, Asthma UK Centre for Applied Research, Edinburgh, said the findings suggest that early use of oral corticosteroids can be recommended for preschool children with a history of previous wheeze or asthma, particularly in those showing moderate-to-severe acute wheeze, while their use in those deemed low-risk  and in those with mild acute wheeze could be deferred.

Furthermore, this approach “could be clinically implementable immediately”, they stressed.

This would both encompass and refine current guideline recommendations; GINA (2023) backed use of oral corticosteroids for children attending emergency departments or those admitted to hospital due to severe exacerbations, while according to SIGN/BTS (2019) they should only be used for hospitalised children with acute wheeze.

The systematic review with individual patient data (IPD) meta-analysis was based on seven clinical trials comparing oral corticosteroids with placebo in 1,728 children aged 12 to 71 months with acute preschool wheeze in any setting. Almost half (49%) received oral corticosteroids (64% male).

Compared with placebo, a greater change in wheeze severity at 4 hours was observed in the oral corticosteroids group (mean difference -0·31; p=0·011).

By 12 hours there was no longer a significant difference between the two groups (-0·02 p=0·68), however, the authors noted that any meaningful comparison was limited by the fact that both arms had converged towards recovery by this time point.

Oral corticosteroids also significantly reduced length of hospital stay (-3·18 hours; p=0·0021), with the reduction greatest in those with a history of wheezing or asthma (-4·54 hours p=0·0007).

“Other risk factors such as personal allergies or parental allergies or parental asthma did not improve outcomes,” the authors noted.

“However, care should be taken not to overinterpret these findings due to multiple testing of subgroups effects,” they stressed.

Also of note, administering oral corticosteroids in emergency departments also significantly reduced length of hospital stay (–3·28 hours) and the need for additional steroids (OR 0.53) than in inpatient settings (mean difference -2.50; OR 0·82).

However, the analysis did not reveal any evidence a long-term benefit from oral corticosteroids versus placebo on outcomes such as rehospitalisation and the need for additional steroids.

On the safety side, oral corticosteroids were linked with a significantly higher risk of vomiting (odds ratio 2.27), although generally adverse events were infrequently reported, according to the paper.

Key limitations of the research included variation in the definition of acute preschool wheeze between the studies and data recording methods.

Nevertheless, the study provides “reliable evidence” of the early benefits of oral corticosteroids in preschool acute wheeze, the authors concluded.