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Common Asthma Treatments Don't Work for Virus-Induced Wheeze
Date:1/21/2009

Preschoolers wheezing from a cold won't benefit from steroids, study finds,,,,

WEDNESDAY, Jan. 21 (HealthDay News) -- Steroid medications that are commonly prescribed to improve asthma symptoms don't help ease wheezing associated with a virus in preschoolers, two new reports suggest.

One study, from British researchers, looked at the use of oral prednisolone and found no significant differences between the treated group of children and those who received a placebo. The second study, from Canadian doctors, assessed inhaled steroids for wheezing associated with a virus, and found that while preventive treatment did reduce the need for rescue medications, the benefits weren't strong enough to outweigh the potential side effects. The research was published in the Jan. 22 issue of the New England Journal of Medicine.

"These are kids who are at the brink. We're still trying to see if they're just having viral-induced wheezing or if they really have asthma, and we've always treated these kids like they have asthma," said Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital in Detroit. "These studies suggest that maybe we don't need to. Maybe we should treat viral-induced wheezing differently."

Part of the problem, she explained, is that it can be difficult to tell if small children actually have asthma, or if they're just wheezing from a cold or some other virus. Babies generally wheeze due to viruses, and in school-aged children, wheeze is often indicative of asthma, but it can be hard to tell the difference in toddlers and preschoolers.

The study of oral prednisolone included 700 children between the ages of 10 months and 60 months. All had virus-induced wheezing. The children were randomly assigned to receive either a five-day course of between 10 milligrams and 20 milligrams prednisolone depending on their age or a placebo for five days.

The researchers found no statistically significant differences between the two groups using measures such as the duration of hospitalization and the need for additional medications.

"Our study provides robust evidence that a short course of oral steroids has no clinical benefit, at least for children with mild to moderately severe [wheezing] attacks," said study senior author Dr. Jonathan Grigg, a professor of pediatric respiratory and environmental medicine at Queen Mary University London.

But, Grigg added, "doctors may still prescribe a course [of oral steroids] on a case-by-case basis, especially in severe attacks."

The second study included 129 children between the ages of 1 and 6 who were randomly assigned to receive 750 micrograms of inhaled fluticasone proprionate twice daily or a placebo. Fluticasone proprionate is an inhaled steroid and is often used as a preventive medication for people with asthma. In this study, the children were given the medication or placebo at the onset of any upper respiratory infection and asked to continue the medication for a maximum of 10 days. They did this over a period of six to 12 months.

Unlike the first study, the researchers did see a slight benefit from using the preventive inhaled steroid medication, but there were also side effects, such as a smaller gain in height and weight, that probably outweighed those benefits.

"These kids have intermittent wheezing with a respiratory virus, with no wheezing in between. Maybe viral-induced wheezing isn't so much inflammation, but an irritability of the airways, so anti-inflammatories [like steroids] don't work. Maybe it's a different pathophysiology with similar symptoms. Not all wheezing is asthma in kids," Appleyard suggested.

She did point out that the findings from these studies don't apply to children with asthma, and that these medications can be very helpful in children with asthma. Children with asthma will wheeze at other times, not just when they have a virus, Appleyard noted.

More information

To learn more about available asthma treatments and how they work, visit the U.S. National Heart, Lung, and Blood Institute.



SOURCES: Jonathan Grigg, M.D., professor, pediatric respiratory and environmental medicine, Queen Mary University London; Jennifer Appleyard, M.D., chief, allergy and immunology, St. John Hospital, Detroit; Jan. 22, 2009, New England Journal of Medicine


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