Study casts doubt over benefit of oral steroid treatment for attacks of wheeze in young children

Current UK and US guidelines advocating parent-administered oral steroid treatment for attacks of wheeze in young children may need to be altered in light of research published in this week's issue of THE LANCET. A randomised trial involving over 200 UK children found that a five-day course of steroids was no more effective than placebo in reducing respiratory symptoms or the need for hospital admission.

Episodic attacks of wheeze triggered by viral colds are common in children aged between 1 and 5 years (preschool viral wheeze). This variant of asthma is considered to be separate from "allergic" asthma, since it frequently disappears by school-age. The minority of wheezy preschool children who develop allergic asthma in later life can be identified by above-average levels of substances released by eosinophils (the key allergy cell) in the blood. Parental-initiated oral steroids given at the first sign of an attack of preschool viral wheeze is currently recommended. In contrast to the beneficial effect of oral steroids for attacks of allergic asthma in adults, the evidence that oral steroids are effective for preschool viral-wheeze is conflicting.

Jonathan Grigg from the University of Leicester, UK, and colleagues studied over 200 young children with a history of viral wheeze. Children were categorised as high or low for eosinophil-released substances in the blood and randomly allocated a five-day course of oral prednisolone or placebo to be given at the start of a wheeze attack. In line with current guidelines, parents administered the treatment and recorded their child's subsequent respiratory symptoms.

Data were available for 120 children (51 who had received prednisolone, 69 placebo). There was no difference in daytime or night-time respiratory symptom scores between those children who received oral prednisolone and those who received placebo. There was also no difference in symptom scores or rate of hospital admission between children in the high and low eosinophil activation groups. A surprising finding was a trend (though not statistically significant) for greater hospital admissions among children given oral prednisolone.

Jonathan Grigg comments: "Current British guidelines for the management of preschool asthma, recommend that parents may be provided with a course of oral steroids as part of a management plan for paediatric asthma. Our findings suggest that this strategy may need re-evaluation for preschool children with viral wheeze, since there are no clear benefits to balance potential risks."

Contact: Dr Jonathan Grigg, Leicester Children's Asthma Centre, University of Leicester, PO Box 65, Leicester, LE2 7LX, UK;
T)44-116-252-5810;
F)44-116-252-3282;
E) jg33@le.ac.uk

Ather Mirza, Director of Press and Publication, University of Leicester;
T) 44-116-252-3335;
M) 44-771-192-7821;
E) Pressoffice@LE.AC.UK

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