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Prednisolone effective in children with wheeze, high rhinovirus load

Young children with rhinovirus-induced wheezing were more likely to benefit from prednisolone treatment if they had a high viral load at presentation, according to recent study results.

In a double blind, randomized study, researchers used PCR to detect rhinovirus in nasopharyngeal aspirate of 79 children who had their first moderate-to-severe wheezing episode between age 3 and 23 months. Treatments were oral prednisolone (first dose of 2 mg/kg, followed by 2 mg/kg/day in two divided doses for 3 days) or placebo, with 12-month follow-up.

“New physician-confirmed wheezing episode within 2 months, number of physician-confirmed wheezing episodes within 12 months and initiation of regular controller medication for asthma symptoms within 12 months” were long-term primary outcomes, the researchers reported. Rhinovirus load was examined by primary interaction analysis.

Seventy-four children (mean age, 13 months; 28% atopic), including 34 (79% boys) in the prednisolone-treatment cohort and 40 (75% boys) in the placebo cohort, completed the study. There was no difference in long-term outcomes between the groups. At 2-week follow-up, children in the prednisolone cohort experienced less cough, rhinitis, noisy breathing, severe breathing difficulties and nocturnal respiratory symptoms at home.

Twenty-five children had rhinovirus load >7,000 copies/mL, with the prednisolone-treatment cohort having a lower number of physician-confirmed new wheezing episodes compared with the placebo-treatment cohort during 2-month follow-up (HR=0.2; 95% CI, 0.1-0.7) and 12-month follow-up (RR=0.6; 95% CI, 0.4-0.98).

“Although the study did not support a beneficial effect of prednisolone for long-term primary outcomes, the prespecified interactional analysis showed that the effect of prednisolone was closely linked to rhinovirus load,” the researchers reported. “Prednisolone cannot be routinely recommended for all young children experiencing their first acute, moderate-to-severe, rhinovirus-induced wheezing episode. Prednisolone might be beneficial in a subgroup of children with high viral loads.”

Disclosure: See the study for a full list of relevant financial disclosures.