The Use of Steroids to Treat Wheezing Children May Be Unnecessary

Treating children with steroids who are wheezing from an infection as opposed to asthma, does not work, a report has shown.

Using steroids to combat wheezing in children under 6 years old has been revealed to be ineffective, according to studies published in the New England Journal of Medicine.

Steroids are often prescribed to children who are brought to doctors with wheezing problems, even if the diagnosis is a virus or infection.

Dr. Andrew Bush of the Imperial School of Medicine and Royal Brompton Hospital in London said that these new studies make it clear that current practice must change. "It is disturbing to contemplate how many unnecessary courses of prednisolone have been given over the years, in good faith, because we all assumed that preschool children are little adults. There is certainly a lesson there for the use of other medications," he wrote.

Around one in three children of pre-school age can develop a wheeze, which 75% of them grow out of before they reach the age of six.

Researchers including Dr. Jonathan Grigg of Queen Mary University found that of 700 children with a wheeze, that took part in the study, the ones given placebo were not in hospital any longer than those who were given a standard five day course of steroid prednisolone. There was also shown to be no difference to the conditions of the two groups in the following week.

Grigg recognises that there is a place for steroid use in more severe cases when longer hospitalisation is required, but that in the general run of things, when children are presented to their doctor with mild to moderate wheezing, steroids are not going to be of any benefit. He also said this result "does fit into the general perception that preschool wheeze is very different from attacks of allergic asthma in older children and adults."

A second study showed that GlaxoSmithKline’s drug Flovent, containing fluticasone did help the symptoms of infection such as a sore throat and congestion more than placebo. In a study of 129 children, only 8% required further treatment when treated with the drug, compared to 18% in the placebo group.

At the first sign of upper respiratory tract infection Flovent was used twice daily for up to 10 days. Despite significant improvement in symptoms, it was worrying that these children grew a tenth of an inch (one-third of a centimetre) less over almost 10 months.

GlaxoSmithKline who founded the study say the dose used was well above recommended dose for childen of that age and that Flovent is not specifically approved for treating wheezing in young children. They do hope though that, "these results may help inform future research efforts into viral-induced wheezing."

L.W.

Source: When kids wheeze, steroids don't help: studies (Yahoo.com) [1]