Oral steroids ineffective in the treatment of preschool virus-induced wheezing

The findings, reported in the January edition of The New England Journal of Medicine, call into question national guidelines for the treatment of viral-induced wheezing.

Attacks of wheezing caused by viral infections in the upper respiratory tract are common in preschool children between the ages of ten months and six years. Preschool children who visit hospital with such symptoms are commonly treated with a short course of prednisolone – a steroid which is used to reduce inflammation in the airway and which is very effective in treating attacks of allergic asthma in older children and adults.

It has recently been recognised that wheeze in most preschool children is only triggered by viral colds, and is therefore a different condition from 'allergic asthma'. There is conflicting evidence whether a short course of oral prednisone is effective in this age group.

Professor Jonathan Grigg, a paediatrician at Barts and The London's, Institute of Cell and Molecular Science, along with colleagues from Leicester and Nottingham Universities, studied a group of 700 children between the ages of 10 and 60 months, who presented to hospital with an attack of wheezing associated with a viral infection. Half were treated with oral prednisolone, half with a placebo, and symptoms monitored by health care professionals.

The team found no significant difference in the length of time the children spent in hospital between the placebo group and the prednisolone group. These findings were consistent with a previous study conducted by the team, where the oral steroid was administered by parents in the home.

Professor Grigg explains: “The result of this large trial suggests that oral prednisolone should not be routinely given to preschool children presenting to the hospital with virus-induced wheezing.”

'Oral prednisolone for preschool children with acute virus-induced wheezing' will be published in the New England Journal of Medicine on 22 January 2009.

The research was funded by a grant from Asthma UK.