Wheezing children: what is the best treatment?

The treatment of a lung condition that affects almost half of all pre-school children is to be investigated by researchers at the Universities of Nottingham and Leicester.

They aim to find a definitive answer on the best way of treating the tens of thousands of children brought into hospitals every year with unexplained wheezing and shortness of breath.

The condition affecting them, known as ‘viral-induced wheezing’, is one of the commonest reasons for young children to be admitted to accident and emergency departments.

For many years, the standard treatment for this condition has been a short course of steroids — the same treatment commonly given to children suffering asthma symptoms.

But while asthma is thought to be triggered by allergies, viral-induced wheezing has different causes. And evidence has been accumulating recently that steroids may not, in fact, be the best approach for young children brought into hospital with viral-induced wheezing.

Researchers at the Universities of Nottingham and Leicester are now to investigate the treatment and establish definitively whether steroids are the best treatment or not.

Dr Jonathan Grigg and Dr Monica Lakhanpaul, both of the University of Leicester, are leading the study. Dr Grigg said: “By combining expertise at Leicester and Nottingham we will be able to recruit a large number of children into the study.

“Its results will therefore be robust enough to have an immediate impact on clinical care.”

Steroids work by reducing inflammation in the airways. But repeated doses can suppress the body’s own natural steroid production, which can have side effects on growth. So if the treatment were actually ineffective for viral-induced wheezing, such side-effects would be suffered unnecessarily.

Up to 700 children are to be enrolled onto the study from Nottingham’s City Hospital, the Queen’s Medical Centre, and Leicester Royal Infirmary over a three-year period. Half will be given steroids and half a placebo, and they will be followed up at one week after treatment and again at four weeks.

The study is being funded with a £200,000 grant from national charity Asthma UK.

Principal investigators at the University of Nottingham are Dr Alan Smyth and Professor Terence Stephenson.

Dr Smyth, senior lecturer in child health, said: “One of the commonest causes for pre-school children to be admitted to hospital is wheezing, and these children are frequently given steroids.

“Because they are effective in some similar conditions, there has been an assumption that steroids will work for viral-induced wheeze. But perhaps we haven’t been right in that assumption.

“We hope to answer an important clinical question, and provide a conclusive answer to the question of what is the best treatment to give to these children.”

Jenny Versnel, Assistant Director Research at Asthma UK said: “Asthma UK welcomes this study to address the uncertainty surrounding the efficacy of oral steroids in children where wheezing is associated with viral infections such as colds.

“It is hoped that results from this study will inform current practice.”