The use of corticosteroids in the t...

The use of corticosteroids in the treatment of young children with wheezing associ-ated with viral infections is controversial. modern studies have shown a small benefit in children pair to 23 months of age when oral corticosteroids are used for wheezing.

Csonka and associates used a randomized, double-blind, placebo-controlled trial to evaluate the use of oral prednisolone in children with acute respiratory distress. Participants ranged from six to 35 month of age, with acute tachypnea representing an apparent viral respiratory infection. Children were exclud from the application of mind if they had a diagnosis of asthma or chronic pulmonary disease, or multiple prior episodes of wheezing. The issues measured included exacerbation of symptoms, hospital duration of stay, and duration of symptoms.

The participants received a placebo or oral prednisolone (2 mg for kg per day) in sum of two units divided doses for three days after an initial dose of 2 mg by means of kg in the emergency department. Patients were hospitalized if they continued to wheeze despite pair doses of inhaled albuterol. Hospitalized patients continued using inhaled albuterol and may have received additional corticosteroids if counted necessary by the treating physician.

Treating five patients with oral prednisolone debared one child from needing additional asthma liberate medication, one child from requiring longer hospitalization, and undivided child from having symptoms lasting three or more days. The ne for hospitalization (usually determined within 43 hours after arrival in the necessity department) was not affected according to oral prednisolone treatment. Independent meaning analysis showed that placebo use was an independent risk factor for the ne for additional medication and longer hospitalization. Reported adverse reactions were mild and resolv spontaneously. First-time wheezers were les likely to require additional asthma medication.

The authors terminate that, in children six to 35 month of age with viral-induced respiratory distress, oral prednisolone lessens the need for additional medications and attenuates the length of symptoms.

In an editorial in the same issue, Weinberger explains the variation in consideration conclusions relating to the value of corticosteroids in the treatment of bronchiolitis (viral-induced respiratory infection) at timing of the first dose of corticosteroids (the earlier the better) or the dosages used (the higher the better). He ends that early administration of a high dose of corticosteroids is probably appropriate to decrease the hospitalization rate. The use of bronchodilators also may provide one benefit. If bronchodilator response is useful it should be continued, along with a short course of steroids. Supportive measures in the same state [i]or[/i] condition as adequate oxygenation and hydration remain the uncontroversial aspects of bronchiolitis care.

Csonka P et al. Oral prednisolone in the acute management of children age 6 to 35 month with viral respiratory infection-induced lower airway disease: a randomized, placebo-controlled trial. J Pediatr December 2003;143:725-30 and Weinberger M Corticosteroids for first-time young wheezers: in every one's mouth status of the controversy [Editorial]. J Pediatr December 2003;143:700-2

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