Prednisolone reduces recurrent wheezing after a first wheezing episode associated with rhinovirus infection or eczema.
BACKGROUND
Rhinovirus-induced early wheezing has been suggested as a new important risk factor for recurrent wheezing.


OBJECTIVE
We sought to investigate the risk factors for recurrent wheezing and to determine post hoc the efficacy of prednisolone in risk groups.


METHODS
We followed for 1 year 118 children (median age, 1.1 years) who had had their first episode of wheezing and had participated in a trial comparing prednisolone with placebo in hospitalized children. Demographics and laboratory data were obtained at study entry. The follow-up outcome was recurrent wheezing (3 physician-confirmed episodes).


RESULTS
Recurrent wheezing was diagnosed in 44 (37%) children. Independent risk factors were age < 1 year, atopy, and maternal asthma. The probability of recurrent wheezing was higher in rhinovirus than respiratory syncytial virus (RSV)-affected children among placebo recipients (hazard ratio, 5.05; 95% CI, 1.00-25.41). Prednisolone decreased the probability of recurrent wheezing in children with eczema (0.15; 95% CI, 0.04-0.63) but not in those without eczema (1.89; 95% CI, 0.83-4.29; P = .007 for interaction). Prednisolone was associated with less recurrent wheezing in the rhinovirus group (0.19; 95% CI, 0.05-0.71), but not in the RSV (2.12; 95% CI, 0.46-9.76) or in the RSV/rhinovirus-negative groups (2.03; 95% CI, 0.83-5.00; P = .017 for interaction).


CONCLUSIONS
Rhinovirus-induced early wheezing is a major viral risk factor for recurrent wheezing. Prednisolone may prevent recurrent wheezing in rhinovirus-affected first-time wheezers. The presence of eczema may also influence the response to prednisolone.


CONCLUSIONS
A prospective trial is needed to test the hypothesis that prednisolone reduces recurrent wheezing in rhinovirus-affected wheezing children.
Lehtinen
Pasi
P
Department of Pediatrics, Turku University Hospital, Finland.
Ruohola
Aino
A
Vanto
Timo
T
Vuorinen
Tytti
T
Ruuskanen
Olli
O
Jartti
Tuomas
T
D002675:Child, Preschool; D015331:Cohort Studies; D004485:Eczema / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010850:Picornaviridae Infections / Q000150:complications*; D010919:Placebos; D011239:Prednisolone / Q000627:therapeutic use*; D012135:Respiratory Sounds / Q000187:drug effects* / Q000209:etiology; D012229:Rhinovirus; D055502:Secondary Prevention; D016896:Treatment Outcome
D010919:Placebos; D011239:Prednisolone