Impact of oral corticosteroids on respiratory outcomes in acute preschool wheeze: a randomised clinical trial Pre-school wheeze is really common, with evidence suggesting that 50% of children will have at least one episode of acute wheeze by the age of 6years. Over the last 10-15years, there have been a number of studies looking at the use of steroid therapy in this group. At this time, whilst we recognise that there are a group of children that will benefit from steroid therapy, the evidence remains unclear as to which children presenting to the ED should be prescribed them. This recent paper from New Zealand is the latest that attempts to answer this question. It describes a randomised control trial designed to assess the impact of steroids on respiratory outcomes in children presenting with pre-school wheeze. The study was a double blinded, randomized control trial of children between the ages of 24 and 59months presenting with acute wheeze. Participants were randomised to either 3 days of Prednisolone 2mg/kg (max 40mg) or placebo and the primary outcome measure was a change in Preschool Respiratory Assessment Measure (PRAM) score at 24hours. A total of 477 patients were included in the analysis. The study found that there was no difference in change of PRAM score at 24 hours between the 2 groups. Interestingly however, they found that:
The authors concluded that whilst there was no change at 24hrs, reduced admission and escalation rates suggest that prednisolone may improve short term respiratory outcomes but that subsequent doses appear to produce no additional benefit. Thus, raising yet more questions regarding the use of steroids in pre-school wheeze. Dr Danielle Scarfe
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October 2021
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