Elsevier

The Journal of Pediatrics

Volume 143, Issue 6, December 2003, Pages 725-730
The Journal of Pediatrics

Oral prednisolone in the acute management of children age 6 to 35 months with viral respiratory infection-induced lower airway disease: a randomized, placebo-controlled trial

https://doi.org/10.1067/S0022-3476(03)00498-0Get rights and content

Abstract

Objective

To investigate the efficacy of oral prednisolone in virally induced respiratory distress.

Study design

Randomized, double-blind, placebo-controlled trial involving 230 children age 6 to 35 months in the emergency department. Each patient received either oral prednisolone (2 mg/kg/d) or placebo for 3 days.

Results

The hospitalization rates were similar between the two groups. For admitted children (n = 123), the median length of stay was 1 day shorter in the prednisolone group (2 vs 3 days, P = .060). The proportion of children requiring ≥3 days of hospitalization was 47.5% in the prednisolone group and 67.7% in the placebo group (P = .023). There was less need for additional asthma medication (18.0% vs 37.1%, P = .018) in the prednisolone group. The median duration of symptoms of respiratory distress was 1 day in the prednisolone group versus 2 days in the placebo group both among the hospitalized (P<.001) and nonhospitalized children (P = .006).

Conclusion

A 3-day course of oral prednisolone effectively reduced disease severity, length of hospital stay, and the duration of symptoms among children 6 to 35 months old with virally induced respiratory distress.

Section snippets

Study population

Children age 6 to 35 months were eligible for the study if, at the time of presentation to the pediatric emergency department (ED) of Tampere University Hospital, they had acute tachypnea, wheezing, or use of accessory respiratory muscles in the presence of an apparent viral respiratory infection (rhinorrhea or temperature >37.5°C).18 Patients were not eligible if they had asthma (documented diagnosis or a history of two or more previous physician-diagnosed wheezing episodes), inspiratory

Results

Between April 1997 and March 1999, a total of 603 acutely wheezing children 6 to 35 months old with no previous diagnosis of asthma attended the ED at Tampere University Hospital. Of these, 136 had two or more previous wheezing episodes and thus were not eligible for inclusion. For the remaining 467 children, the trial profile is illustrated in Figure 1.

There was no major difference in baseline characteristics between the two intervention arms (Table I) or between children hospitalized and not

Discussion

This study demonstrated that children 6 to 35 months old with virally induced respiratory distress benefited from a 3-day course of oral prednisolone treatment. Those given the active preparation had fewer symptomatic days, were less likely to receive additional asthma medication, and were more likely to be discharged.

The beneficial effect of oral prednisolone was independent of the child's earlier wheezing history. However, first-time wheezers were less likely to need additional asthma

Acknowledgements

We give special thanks to the parents of the children and to the staff of the Pediatric Department or Tampere University Hospital. Without their cooperation, this investigation could have never been accomplished.

References (24)

  • R.J Scarfone et al.

    Controlled trial of oral prednisone in the emergency department treatment of children with acute asthma

    Pediatrics

    (1993)
  • L Horowitz et al.

    Acute asthma: single dose oral steroids in paediatric community clinics

    Eur J Pediatr

    (1994)
  • Cited by (81)

    • Viral Infections and Wheezing in Preschool Children

      2022, Immunology and Allergy Clinics of North America
      Citation Excerpt :

      The older children aged 24 to 54 months had a smaller difference in admission rates with 23% versus 31% requiring admission.47 Another study involving 230 children aged 6 to 35 months presenting to the ED with acute respiratory distress were randomized to 3 days of oral prednisone versus placebo.48 Children were hospitalized at similar rates between the 2 groups but those treated with OCS had a shorter hospital duration by 1 day, 2 versus 3 days, in treatment versus placebo cohorts, respectively.

    • Management of Asthma in the Preschool Child

      2019, Immunology and Allergy Clinics of North America
      Citation Excerpt :

      OCS are frequently prescribed for acute severe exacerbations in this age group, although there is limited evidence for consistent efficacy in this age group, and this efficacy seems to be related to severity of episode and site of care. Several studies in the preschool population have reported that OCS use in the ED setting was associated with decreased symptoms and length of hospital stay.46–48 A multicenter trial of children ages 1 to 17 years with moderate or severe asthma receiving OCS and inhaled bronchodilators in the ED found that OCS dosing was not associated with management failure, defined as subsequent hospitalization, prolonged symptoms, and rebound ED visits.49

    • Oral prednisolone in preschool children with virus-associated wheeze: a prospective, randomised, double-blind, placebo-controlled trial

      2018, The Lancet Respiratory Medicine
      Citation Excerpt :

      The beneficial role of corticosteroid administration in reducing the need for adults to seek hospital admission during asthma episodes has been shown,10 but the evidence supporting corticosteroid use in paediatric wheeze exacerbations is less robust.11 In particular, studies aimed at assessing the efficacy of corticosteroids on preschool children with wheeze have produced contradictory findings.12–14 Panickar and colleagues,14 having completed the largest of these studies to date, found no positive effect of corticosteroids.

    • Infections and Asthma: Impact on the Natural History of Asthma

      2016, Pediatric Allergy: Principles and Practice: Third Edition
    View all citing articles on Scopus

    Supported by grants from the Emil Aaltonen Foundation; the Finnish Allergy Research Foundation; the Foundation for Pediatric Research, Finland; the Medical Research Fund of Tampere University Hospital; the Support Fund for the Department of Pediatrics; the Tampere University Research Foundation; and the Tuberculosis Foundation of Tampere.

    View full text