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Am Fam Physician. 2004;70(5):947-948

The use of corticosteroids in the treatment of young children with wheezing associated with viral infections is controversial. Recent studies have shown a small benefit in children two 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 months of age, with acute tachypnea representing an apparent viral respiratory infection. Children were excluded from the study if they had a diagnosis of asthma or chronic pulmonary disease, or multiple prior episodes of wheezing. The outcomes measured included exacerbation of symptoms, hospital length of stay, and duration of symptoms.

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

Treating five patients with oral prednisolone prevented one child from needing additional asthma rescue medication, one child from requiring longer hospitalization, and one child from having symptoms lasting three or more days. The need for hospitalization (usually determined within 4.3 hours after arrival in the emergency department) was not affected by oral prednisolone treatment. Independent effect analysis showed that placebo use was an independent risk factor for the need for additional medication and longer hospitalization. Reported adverse reactions were mild and resolved spontaneously. First-time wheezers were less likely to require additional asthma medication.

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

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

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