The Headline:
“Children who wheeze because of a virus ‘should not be given steroids’ ” reports The Daily Telegraph. The claim is based on a trial of steroid drugs commonly given as a pill to young children suffering from wheezing. It said that steroids are commonly given to children with wheeze as the drug is known to ease the symptoms of asthma, which are similar. The newspaper said that more effective treatment needed to be found for treating asthma-free children who had wheeze.
NHS Choices says that:
As the researchers discuss, this study (and one prior, related study) have found no effect from the use of prednisolone for children with viral-induced wheeze. They say this conflicts with the findings from other studies. The authors go on to discuss the possible reasons for this conflict, including the study’s use of PRAM scores, which the researchers say are a valid measure of symptoms.
In their discussion the researchers say that the majority of the children in their study did not have “classic atopic asthma phenotype”, which is asthma due to allergies and exposure to environmental allergens. They say that children who do not have this form of asthma may not respond to corticosteroids.
They researchers raise the most important shortcomings of their sampling:
- That a substantial number of children were eligible for the study, but their parents did not give consent.
- The outcome of the study may have been different if it had included those children who did not participate. This is because parents may have declined based on factors such as the reasons for their their child’s symptoms or their severity.
- Some studies suggest that response to corticosteroids in children with viral-induced wheeze may be due to the type of virus infecting the child.
- This study did not have the means to compare the response in children infected with different types of virus.
An important point in addition to these is current guidance from the British Thoracic Society and the Scottish Intercollegiate Guidelines Network (which has been updated since the 2003 edition referenced by this study) suggests that oral steroids should be prescribed in hospital for very young children with moderate to severe episodes of asthma.
Importantly, this guidance is specific to children who have a diagnosis of asthma, and not explicitly for treatment of viral-induced wheezing in children who may or may not have asthma. The findings of this study should not impact on guidance for treating asthmatic children as the participants had post-infectious wheeze and most did not have proper “asthma”.
Also, in very young children a diagnosis of asthma is notoriously difficult due to the range of presentations. Often nocturnal cough is the only symptom of asthma, while wheezing symptoms will commonly indicate a “cold” but not necessarily asthma.
Links to the Headlines:
Doubt over child asthma tactic. BBC online, January 22 2009
Children who wheeze because of a virus 'should not be given steroids'. The Daily Telegraph, January 22 2009
Links to the Science:
Panickar J, Lakhanpaul M, Lambert PC et al. Oral Prednisolone for Preschool Children with Acute Virus-Induced Wheezing. NEJM, 2009 Volume 360:329-338 No 4 January 22 2009
