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Prednisolone for the first rhinovirus-induced wheezing and 4-year asthma risk: A randomized trial
Annamari Koistinen1, Minna Lukkarinen1,2, Riitta Turunen1,3
1Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
Insights
Corticosteroid treatment (prednisolone) did not affect asthma medication initiation for first-time wheezing in children. However, prednisolone may benefit those with severe episodes and high rhinovirus load.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Virology
Background:
- Recurrent wheezing in children is a concern.
- Corticosteroid treatment for the first wheezing episode may reduce recurrence in children with high rhinovirus load.
- Longer-term effects of this treatment are not well-studied.
Purpose of the Study:
- To investigate the long-term effects of early corticosteroid treatment on asthma development.
- To determine if prednisolone influences the time to initiation of asthma control medication in children after their first wheezing episode.
- To examine the role of rhinovirus load in modifying treatment effects.
Main Methods:
- 79 children with their first acute wheezing episode were randomized to receive prednisolone or placebo for 3 days.
- PCR confirmed rhinovirus presence.
- The primary outcome was the time to initiation of regular asthma control medication before age 5.
- Interaction analysis explored the effect of rhinovirus genome load.
Main Results:
- 59 children completed follow-up; 68% initiated asthma medication by a median age of 20 months.
- Overall, prednisolone did not significantly alter the time to asthma medication initiation compared to placebo.
- Rhinovirus load modified prednisolone's effect (P=.04).
- In children with high rhinovirus load (>7000 copies/mL), prednisolone use was associated with a lower risk of medication initiation (P=.05).
Conclusions:
- Prednisolone did not impact the overall time to asthma control medication initiation after the first wheezing episode.
- Prednisolone may offer benefits for children experiencing severe first-time wheezing associated with a high rhinovirus load.
- Further research into targeted corticosteroid use based on viral load is warranted.
Background:
Previous findings show that corticosteroid treatment during the first acute wheezing episode may reduce recurrent wheezing in children with high rhinovirus genome load at 12-month follow-up. Longer-term effects have not been investigated prospectively.
Methods:
After PCR confirmation of rhinovirus from nasopharyngeal aspirate, 79 children with the first acute wheezing episode were randomized to receive orally prednisolone or placebo for 3 days. The initiation of asthma control medication before the age of 5 years was confirmed from medical record and/or from parental interview. The outcome was the time to initiation of regular asthma control medication. Interaction analysis examined rhinovirus genome load.
Results:
Fifty-nine (75%) children completed the follow-up. Asthma control medication was initiated in 40 (68%) children at the median age of 20 months. Overall, prednisolone did not affect the time to initiation of asthma control medication when compared to placebo (P=.99). Rhinovirus load modified the effect of prednisolone regarding the time to initiation of asthma control medication (P-value for interaction=.04). In children with high rhinovirus load (>7000 copies/mL; n=23), the risk for initiation of medication was lower in the prednisolone group compared to the placebo group (P=.05). In the placebo group, asthma medication was initiated to all children with high rhinovirus load (n=9) during the 14 months after the first wheezing episode.
Conclusions:
Overall, prednisolone did not affect the time to initiation of asthma control medication when compared to placebo. However, prednisolone may be beneficial in first-time wheezing children whose episode was severe and associated with high rhinovirus load. (ClinicalTrials.gov, NCT00731575).
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