Short- and long-term efficacy of prednisolone for first acute rhinovirus-induced wheezing episode

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:135

Article

Jartti, Tuomas¹  Nieminen, Riitta^1,2  Vuorinen, Tytti²  Lehtinen, Pasi¹  Vahlberg, Tero³  Gern, James^4,5  Camargo, Carlos A., Jr.^6,7  Ruuskanen, Olli¹ 

[1] Turku Univ Hosp, Dept Pediat, FIN-20520 Turku, Finland

[2] Univ Turku, Dept Virol, SF-20500 Turku, Finland

[3] Univ Turku, Dept Biostat, SF-20500 Turku, Finland

[4] Univ Wisconsin, Sch Med & Publ Hlth, Dept Pediat, Madison, WI 53706 USA

[5] Univ Wisconsin, Sch Med & Publ Hlth, Dept Med, Madison, WI 53706 USA

[6] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Emergency Med, Boston, MA USA

[7] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Div Rheumatol Allergy & Immunol,Dept Med, Boston, MA USA

关键词: Bronchiolitis;    child;    corticosteroid;    glucocorticoid;    treatment;    prednisolone;    rhinovirus;    virus;    wheeze;    wheezing;   

DOI  :  10.1016/j.jaci.2014.07.001

来源: Elsevier

【 摘 要 】

Background: Rhinovirus-induced wheezing is an important risk factor for recurrent wheezing. There are no randomized controlled trials on the effect of systemic corticosteroids in patients with this disease. Objective: We sought to study the short-and long-term effects of prednisolone treatment of the first acute, moderate-to-severe, rhinovirus-induced wheezing episode in young children. Methods: After confirming rhinovirus from nasopharyngeal aspirate by using PCR, 79 children with a first wheezing episode at age 3 to 23 months were randomized to receive oral prednisolone (first dose of 2 mg/kg, followed by 2 mg/kg/d in 2 divided doses for 3 days) or placebo. The trial was double blind throughout the 12-month follow-up. The primary outcomes were long term: new physician-confirmed wheezing episode within 2 months, number of physician-confirmed wheezing episodes within 12 months, and initiation of regular controller medication for asthma symptoms within 12 months. The primary interaction analysis examined rhinovirus load. Results: Seventy-four patients completed the study (mean age, 13 months; 28% atopic). Long-term outcomes did not differ between groups (all P >= .30). For short-term outcomes, the prednisolone group had less cough, rhinitis, noisy breathing, severe breathing difficulties, and nocturnal respiratory symptoms at home within 2 weeks (all P <.05). The 25 children with greater than 7000 rhinovirus copies/mL (most sensitive cutoff) benefitted from prednisolone in terms of less risk of physician-confirmed recurrence within 2 and 12 months compared with placebo (both P <.05). Conclusions: Prednisolone cannot be routinely recommended for all young children experiencing their first acute, moderate-to-severe, rhinovirus-induced wheezing episode. Prednisolone might be beneficial in a subgroup of children with high viral loads.

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