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Published on: May 10, 2024
Parent-initiated oral corticosteroid therapy for intermittent wheezing illnesses in children
P Vuillermin1, M South, C Robertson
1Royal Children's Hospital, Melbourne & Geelong Hospital, Melbourne, Australia. peter.vuillermin@telstra.com
Insights
Parent-initiated oral corticosteroids (OCS) for childhood wheezing offer no clear benefits and may have risks. More research is needed to determine if early OCS treatment is safe and effective for managing wheezing illnesses in children.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Intermittent wheezing illnesses, including viral-associated wheeze and asthma, are common pediatric respiratory conditions.
- The decision for parents to administer oral corticosteroids (OCS) for acute wheezing without medical review involves balancing potential benefits against adverse effects.
Purpose of the Study:
- To evaluate the benefits and harms of parent-initiated OCS for managing intermittent wheezing illnesses in children.
- To synthesize findings from randomized clinical trials on early OCS intervention in pediatric wheezing.
Main Methods:
- A systematic search of multiple databases (e.g., CENTRAL, MEDLINE, EMBASE) was conducted up to November 2005.
- Included were randomized clinical trials involving children aged 1-18 with intermittent wheezing, comparing OCS to placebo or other treatments.
- Two reviewers independently selected trials, assessed quality, and extracted data.
Main Results:
- Two high-quality randomized trials with 303 participants were included.
- No evidence supported parent-initiated OCS for improved hospital admissions, unscheduled reviews, symptom scores, or other clinical outcomes.
- Adverse effects of early OCS treatment were not adequately documented.
Conclusions:
- Current evidence on the efficacy of parent-initiated OCS for childhood intermittent wheezing is limited and inconclusive.
- Widespread adoption of this management strategy is not recommended until benefits and harms are better understood.
- Further research is necessary to clarify the role of early OCS in pediatric wheezing management.
Background:
Intermittent wheezing illnesses, which include viral associated wheeze and asthma, are amongst the most common reasons for children to present urgently to a doctor. Whether parents should commence oral corticosteroids (OCS) for an episode of acute wheeze in their child without waiting for a medical review is an important question, as the potential benefits of early oral corticosteroid intervention have to be weighed against the potential adverse effects of treatment.
Objectives:
The objectives were to assess the benefits and harmful effects of parent-initiated OCS, in the management of intermittent wheezing illnesses in children, based on the results of randomised clinical trials.
Search Strategy:
The Cochrane Airways Group Specialised Register, The Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE, LILACS, Web of Science and Dissertation Abstracts were combined (all searched November 2005). Manufacturers and researchers in the field were also contacted.
Selection Criteria:
Only randomised clinical trials studying patients aged between one and eighteen years old, with an intermittent wheezing illness (asthma, viral wheeze, preschool viral wheeze) were included. Interventions encompassed OCS at any dose or duration versus placebo or other drug combination. The trials could be unpublished or published and no language limitations were applied.
Data Collection And Analysis:
Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data. The statistical package (RevMan 4.2) provided by the Cochrane Collaboration was used.
Main Results:
From 572 original citations, a total of 2 randomised clinical trials (303 randomised participants) were included. The quality of the included trials was high; however, marked clinical heterogeneity precluded a meta-analysis. The two trials did not find evidence that parent-initiated OCS are associated with a benefit in terms of hospital admissions, unscheduled medical reviews, symptoms scores, bronchodilator use, parent and patient impressions, physician assessment, or days lost from work or school. Adverse outcomes were inadequately documented.
Authors' Conclusions:
Limited current evidence is available and it is inconclusive regarding the benefit from parent-initiated OCS in the treatment of intermittent wheezing illnesses in children. Widespread use of this strategy cannot be recommended until the benefits and harms can be clarified further.
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