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Previous Volume 360:329-338 January 22, 2009 Number 4 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set CME Exam Supplementary Material Editorial by Bush, A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Attacks of wheezing induced by upper respiratory viral infections are common in preschool children between the ages of 10 months and 6 years. A short course of oral prednisolone is widely used to treat preschool children with wheezing who present to a hospital, but there is conflicting evidence regarding its efficacy in this age group.

Methods We conducted a randomized, double-blind, placebo-controlled trial comparing a 5-day course of oral prednisolone (10 mg once a day for children 10 to 24 months of age and 20 mg once a day for older children) with placebo in 700 children between the ages of 10 months and 60 months. The children presented to three hospitals in England with an attack of wheezing associated with a viral infection; 687 children were included in the intention-to-treat analysis (343 in the prednisolone group and 344 in the placebo group). The primary outcome was the duration of hospitalization. Secondary outcomes were the score on the Preschool Respiratory Assessment Measure, albuterol use, and a 7-day symptom score.

Results There was no significant difference in the duration of hospitalization between the placebo group and the prednisolone group (13.9 hours vs. 11.0 hours; ratio of geometric means, 0.90; 95% confidence interval, 0.77 to 1.05) or in the interval between hospital admission and signoff for discharge by a physician. In addition, there was no significant difference between the two study groups for any of the secondary outcomes or for the number of adverse events.

Conclusions In preschool children presenting to a hospital with mild-to-moderate wheezing associated with a viral infection, oral prednisolone was not superior to placebo. (Current Controlled Trials number, ISRCTN58363576 [controlled-trials.com] .)

Source Information

From the Division of Child Health (J.P., M.L., P.K.) and the Centre for Biostatistics and Genetic Epidemiology, Department of Health Sciences (P.C.L.), University of Leicester, Leicester; the Division of Child Health, University of Nottingham, University Hospital Queen's Medical Centre, Nottingham (T.S., A.S.); and the Centre for Paediatrics, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London (J.G.) — all in the United Kingdom.

Address reprint requests to Dr. Grigg at Paediatric Respiratory and Environmental Medicine, Centre for Paediatrics, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, 4 Newark St., London E1 2AT, United Kingdom, or at j.grigg{at}qmul.ac.uk.

Full Text of this Article

Related Letters:

Oral Corticosteroids in Children with Wheezing
Koumbourlis A. C., Weinberger M., Ducharme F. M., Zemek R. L., Schuh S., Mroueh S., Walter A. W., Lambert P., Grigg J., Bush A.
Extract | Full Text | PDF  
N Engl J Med 2009; 360:1673-1676, Apr 16, 2009. Correspondence

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