Oral corticosteroids don't improve acute wheeze in preschool children: BMJ
New Zealand: The administration of oral prednisolone had no effect on respiratory outcomes at 24 hours or beyond in preschool children with acute wheeze, finds a recent study in the BMJ journal Archives of Disease in Childhood.
Alexandra Wallace, Department of Paediatrics, Waikato Hospital, Hamilton, New Zealand, and colleagues conducted the double-blind, randomised, placebo-controlled equivalence trial at three hospitals in New Zealand to determine if administration of oral prednisolone alters respiratory outcomes in 477 preschool children (aged 24–59 months) with acute wheeze associated with respiratory illness.
They were given 2 mg/kg (maximum 40 mg) oral prednisolone or similar placebo, once daily for 3 days.
Primary outcome was change in Preschool Respiratory Assessment Measure (PRAM) score 24 hours after intervention. Secondary outcomes included PRAM score at 4 hours, admission and representation rates, length of emergency department and inpatient stays, time to return to normal activities and use of additional oral prednisolone or intravenous medications.
Key findings of the study include:
- There was no difference between groups for change in PRAM score at 24 hours.
- Absolute PRAM score was lower in the prednisolone group at 4 hours (median (IQR) 1 (0–2) vs 2 (0–3)) and 24 hours (0 (0–1) vs 0 (0–1)), when symptoms had resolved for most children regardless of initial treatment.
- Admission rate, requirement for additional oral prednisolone and use of intravenous medication were lower in the prednisolone group, although there were no differences between groups for time taken to return to normal activities or rates of representation within 7 days.
"Oral prednisolone does not alter respiratory outcomes at 24 hours or beyond in preschool children presenting with acute wheeze," concluded the authors.
"Impact of oral corticosteroids on respiratory outcomes in acute preschool wheeze: a randomised clinical trial," is published in the BMJ journal Archives of Disease in Childhood.
DOI: https://adc.bmj.com/content/early/2020/10/15/archdischild-2020-318971
