Prednisolone reduces recurrent wheezing after a first wheezing episode associated with rhinovirus infection or eczema
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Updated: May 7, 2026
Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
Pasi Lehtinen1, Aino Ruohola, Timo Vanto
1Department of Pediatrics, Turku University Hospital, Finland.
Insights
Rhinovirus infections in infants are a key risk factor for recurrent wheezing. Early prednisolone treatment may help prevent recurrent wheezing in infants with rhinovirus infections, especially those with eczema.
Area of Science:
- Pediatric Pulmonology
- Viral Respiratory Infections
- Asthma Research
Background:
- Early wheezing episodes in infants are increasingly recognized as a potential risk factor for developing recurrent wheezing.
- Rhinovirus infections are implicated as a significant trigger for these initial wheezing episodes.
Purpose of the Study:
- To identify risk factors associated with recurrent wheezing in young children.
- To evaluate the effectiveness of prednisolone in preventing recurrent wheezing within specific risk groups.
Main Methods:
- A 1-year follow-up study of 118 children (median age 1.1 years) hospitalized for their first wheezing episode.
- Children were part of a randomized trial comparing prednisolone and placebo.
- Data collected included demographics, laboratory results, and physician-confirmed recurrent wheezing episodes (≥3).
Main Results:
- Recurrent wheezing occurred in 37% of children. Independent risk factors identified were age under 1 year, atopy, and maternal asthma.
- In placebo recipients, rhinovirus-infected children had a significantly higher risk of recurrent wheezing compared to RSV-infected children.
- Prednisolone reduced recurrent wheezing in children with eczema and those with rhinovirus infections, but not in other groups.
Conclusions:
- Rhinovirus-induced early wheezing is a primary viral risk factor for recurrent wheezing in infants.
- Prednisolone shows potential in preventing recurrent wheezing in first-time wheezers with rhinovirus infections, particularly those with eczema.
- Further prospective trials are warranted to confirm the efficacy of prednisolone in this specific population.
Background:
Rhinovirus-induced early wheezing has been suggested as a new important risk factor for recurrent wheezing.
Objective:
We sought to investigate the risk factors for recurrent wheezing and to determine post hoc the efficacy of prednisolone in risk groups.
Methods:
We followed for 1 year 118 children (median age, 1.1 years) who had had their first episode of wheezing and had participated in a trial comparing prednisolone with placebo in hospitalized children. Demographics and laboratory data were obtained at study entry. The follow-up outcome was recurrent wheezing (3 physician-confirmed episodes).
Results:
Recurrent wheezing was diagnosed in 44 (37%) children. Independent risk factors were age < 1 year, atopy, and maternal asthma. The probability of recurrent wheezing was higher in rhinovirus than respiratory syncytial virus (RSV)-affected children among placebo recipients (hazard ratio, 5.05; 95% CI, 1.00-25.41). Prednisolone decreased the probability of recurrent wheezing in children with eczema (0.15; 95% CI, 0.04-0.63) but not in those without eczema (1.89; 95% CI, 0.83-4.29; P = .007 for interaction). Prednisolone was associated with less recurrent wheezing in the rhinovirus group (0.19; 95% CI, 0.05-0.71), but not in the RSV (2.12; 95% CI, 0.46-9.76) or in the RSV/rhinovirus-negative groups (2.03; 95% CI, 0.83-5.00; P = .017 for interaction).
Conclusion:
Rhinovirus-induced early wheezing is a major viral risk factor for recurrent wheezing. Prednisolone may prevent recurrent wheezing in rhinovirus-affected first-time wheezers. The presence of eczema may also influence the response to prednisolone.
Clinical Implications:
A prospective trial is needed to test the hypothesis that prednisolone reduces recurrent wheezing in rhinovirus-affected wheezing children.
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