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Systemic Glucocorticoids for Childhood Wheezing

Am Fam Physician. 2003 Feb 1;67(3):517-617.

Acute expiratory wheezing, called bronchiolitis when the first episode occurs before 12 months of age, is common among children of all ages. Recurrences are often termed “wheezy bronchitis,” which presents similarly to virus-induced asthma in older children. Acute bronchiolitis usually is caused by respiratory syncytial virus (RSV). Wheezy bronchitis is most often caused by rhinovirus infections, which are also a common cause of asthma exacerbations. Systemic glucocorticoids often are used to treat children with RSV bronchiolitis, even though efficacy in this situation has not been clearly documented. Jartti and associates used a literature review to evaluate the efficacy of systemic glucocorticoids in various childhood ages and viral etiologies. Only studies that were randomized and placebo-controlled in children younger than 16 years were included. One study in infants younger than 12 months did not find dexamethasone to be convincingly better than placebo, although a smaller study found that a combination of dexamethasone and salbutamol improved the clinical score but not the duration of hospital treatment. Among children younger than three years, six studies that focused on the first wheezing episode found positive results when steroids were used in the outpatient setting but less efficacy in the treatment of hospitalized patients. Among young children who had repeat wheezing episodes, one study did not find glucocorticoids useful in hospitalized children.

Among preschool- and school-aged children, those with asthma benefited from systemic steroids in outpatient, emergency department, and inpatient settings. Efficacy in inpatients was confined to children older than two years. Duration of hospitalization and readmission rates were lower among treated children.

The value of systemic steroids among varying viral etiologies has not been well studied. The few studies that looked specifically at RSV-infected children demonstrated mixed treatment efficacy. Among all of the glucocorticoid studies, there were no meaningful adverse effects.

The authors conclude that systemic glucocorticoids are most effective among children older than two years who have acute asthma. Among children under age two with a first attack, treatment may decrease the need for or duration of hospitalization, although efficacy is absent among inpatients with a first or recurrent attack. RSV bronchiolitis does not respond to systemic glucocorticoids, but rhinovirus infection–induced asthma may be more sensitive to systemic glucocorticoids because of virus-specific immune responses. There are no studies of the long-term efficacy of glucocorticoids among these children.

Jartti T, et al. Systemic glucocorticoids in childhood expiratory wheezing: relation between age and viral etiology with efficacy. Pediatr Infect Dis J. September 2002;21:873–8.


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