title: Short- and long-term efficacy of prednisolone for first acute rhinovirus-induced wheezing episode.
abstract: BACKGROUND
  Rhinovirus-induced wheezing is an important risk factor for recurrent wheezing. There are no randomized controlled trials on the effect of systemic corticosteroids in patients with this disease.
  
  
  OBJECTIVE
  We sought to study the short- and long-term effects of prednisolone treatment of the first acute, moderate-to-severe, rhinovirus-induced wheezing episode in young children.
  
  
  METHODS
  After confirming rhinovirus from nasopharyngeal aspirate by using PCR, 79 children with a first wheezing episode at age 3 to 23 months were randomized to receive oral prednisolone (first dose of 2 mg/kg, followed by 2 mg/kg/d in 2 divided doses for 3 days) or placebo. The trial was double blind throughout the 12-month follow-up. The primary outcomes were long term: new physician-confirmed wheezing episode within 2 months, number of physician-confirmed wheezing episodes within 12 months, and initiation of regular controller medication for asthma symptoms within 12 months. The primary interaction analysis examined rhinovirus load.
  
  
  RESULTS
  Seventy-four patients completed the study (mean age, 13 months; 28% atopic). Long-term outcomes did not differ between groups (all P ≥ .30). For short-term outcomes, the prednisolone group had less cough, rhinitis, noisy breathing, severe breathing difficulties, and nocturnal respiratory symptoms at home within 2 weeks (all P < .05). The 25 children with greater than 7000 rhinovirus copies/mL (most sensitive cutoff) benefitted from prednisolone in terms of less risk of physician-confirmed recurrence within 2 and 12 months compared with placebo (both P < .05).
  
  
  CONCLUSIONS
  Prednisolone cannot be routinely recommended for all young children experiencing their first acute, moderate-to-severe, rhinovirus-induced wheezing episode. Prednisolone might be beneficial in a subgroup of children with high viral loads.
authors.affiliation: Department of Pediatrics, Turku University Hospital, Turku, Finland. Electronic address: tuomas.jartti@utu.fi.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Jartti
authors.affiliation: Department of Pediatrics, Turku University Hospital, Turku, Finland; Department of Virology, University of Turku, Turku, Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Nieminen
authors.affiliation: Department of Virology, University of Turku, Turku, Finland.
authors.forename: Tytti
authors.initials: T
authors.lastname: Vuorinen
authors.affiliation: Department of Pediatrics, Turku University Hospital, Turku, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Lehtinen
authors.affiliation: Department of Biostatistics, University of Turku, Turku, Finland.
authors.forename: Tero
authors.initials: T
authors.lastname: Vahlberg
authors.affiliation: Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: James
authors.initials: J
authors.lastname: Gern
authors.affiliation: Department of Emergency Medicine and Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Department of Pediatrics, Turku University Hospital, Turku, Finland.
authors.forename: Olli
authors.initials: O
authors.lastname: Ruuskanen
mesh_terms: D000208:Acute Disease; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010850:Picornaviridae Infections / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D011239:Prednisolone / Q000627:therapeutic use*; D012135:Respiratory Sounds / Q000187:drug effects* / Q000503:physiopathology; D012229:Rhinovirus / Q000502:physiology*; D012720:Severity of Illness Index; D019562:Viral Load
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone
keywords: Bronchiolitis; child; corticosteroid; glucocorticoid; prednisolone; rhinovirus; treatment; virus; wheeze; wheezing