Oral prednisolone strikes out in children with acute wheeze

Oral prednisolone falls short of improving respiratory outcomes within a day or beyond in preschool children with acute wheeze, a study has shown.

The study included 477 children aged 24–59 months with acute wheeze associated with respiratory illness. These children were randomized to treatment with 2 mg/kg (maximum 40 mg) of oral prednisolone (n=238) or similar placebo (n=239), administered once daily for 3 days.

There was no significant between-group difference observed in the primary outcome of Preschool Respiratory Assessment Measure (PRAM) score 24 hours after intervention (mean difference, −0.39, 95 percent confidence interval [CI], −0.84 to 0.06; p=0.09).

Absolute PRAM score was lower with prednisolone at 4 hours (median, 1 vs 2; p=0.01) and at 24 hours (median, 0 vs 0; p=0.01), although at this time point, symptoms had resolved for most children regardless of initial treatment.

There were fewer children in the active treatment group who received additional oral prednisolone (odds ratio [OR], 0.22) or treatment with intravenous medication (salbutamol, hydrocortisone, magnesium sulphate, or aminophylline; OR, 0.27).

Hospital admission was lower and emergency department stay was shorter in the prednisolone group, although the differences vs placebo were of borderline significance.

Meanwhile, the time it had taken to return to normal activities or rates of representation within 7 days was similar in the two treatment groups.