Wheezing is common in preschool children between the ages of 10 months and 6 years. It is a sound associated with breathing that occurs when there is some kind of blockage
of the respiratory system. When wheezing attacks are caused by upper respiratory viral infections, the standard treatment is a short course of oral prednisolone, but there is conflicting evidence regarding its effectiveness for children in this age group.
The authors conducted a randomized double-blind placebo-controlled trial to assess the effectiveness of oral prednisolone. Outcomes were measured in terms of the length of hospital stay, the score on the Preschool Respiratory Assessment Measure, albuterol use, and a 7-day symptom score.
Results showed that there were not significant differences on any of the outcome measures between using prednisolone and using a placebo.
COMMENT
♣ Prednisolone is a corticosteroid drug that has anti-inflammatory properties. This study’s findings conflict with those of other studies that report a beneficial effect of corticosteroids in the treatment of wheezing.
♣ The authors believe that the main reason why their study’s findings differ is because the children in this study did not present with the classic symptoms of allergy-induced asthma, which is responsive to a short course of oral corticosteroids.
♣ The authors of this study did not analyze the viral infections that caused these children to wheeze, so it is not known whether they suffered from one type of virus or several.
♣ Since a recent study (Jartti et al. 2006) has raised the possibility that children respond to corticosteroid treatment differently as a function of the type of virus they are infected with, it seems important to pursue this line of research by first identifying the viruses, and then designing experiments to test various kinds of treatment.
To read this study in its entirety, go to N ENGL J MED 360:4, January 22, 2009, pp. 329-338
-–Cynthia Haggard is a medical writer who lives in Washington DC. She owns her own business, Clarifying Concepts, which provides technical writing, writing for the public, and regulatory affairs services. To see more, please go to clarifyingconcepts. (c) 2009 All rights reserved.
