Get Nasty with Wheezing Through Steroids
Systemic steroids can very well be the cure to the first or second episode of rhinovirus-induced kind of wheezing in children.
This is the finding of the two-year study conducted by Tuomas Jartti, MD, and his colleagues at the Turku University Hospital in Finland. Published in the Pediatric Infectious Diseases Journal, the study indicated that the use of systemic steroids like prednisolone in treating first or second episode of wheezing in children is beneficial. But this proves to be only effective in rhinovirus-induced kind of wheezing but not for respiratory syncytial virus-induced wheezing.
The main outcome of the study included the time until readiness for discharge. The secondary outcomes were oxygen saturation during hospitalization, duration of symptoms, occurrence of relapses during the next two months, and blood eosinophil or white blood cell count at discharge and two weeks later.
The two-year study involved 293 children admitted for acute wheezing. These children were randomized but only 78 hospitalized children aged between three months and 35 months completed hospitalization --- 37 (47%) were aged 3 to 12 months; 30 (38%) were aged 12 to 23 months; and 11 (14%) were aged 24 to 35 months. These children were prescribed to take oral prednisolone (2 mg/kg/day in 3 divided doses for 3 days) or placebo.
The children that served as subjects of study had first or second episodes of wheezing caused by either rhinovirus or respiratory syncytial virus infection. But children: (a) with age younger than three months or at least three years; (b) with more than one previous wheezing episode; (c) who inhaled corticosteroids, systemic corticosteroids in the previous four weeks; (d) with chronic disease other than allergy or asthma; (e) who need for intensive care; (f) infected by virus other than rhinovirus or RSV, mixed viral infection; and (g) with negative virus test results were excluded in the study.
Results showed that the prednisolone did not affect the time for the readiness for discharge but it decreased relapses during the subsequent two-month period after the first episodes of wheezing in rhinovirus-affected children. But such was not the case for children with respiratory syncytial virus-induced wheezing. This proved that systemic steroids are beneficial to children with first or second episode of wheezing and/or have elevated blood eosinophils or white blood cell count.
The authors study surmised that the children that had episodes of wheezing due to rhinovirus may have responded to the prednisolone type of systemic steroid given the dosages used (2 mg/kg/day in 3 divided doses for 3 days )because of the type of virus associated with wheezing. The children with wheezing episodes caused by rhinovirus responded to systemic steroid while those with wheezing caused by respiratory syncytial virus did not.
Systemic steroids reduce the inflammation in the passageway of air. Systemic steroids top in the management of acute asthma usually associated with wheezing. Wheezing is a high-pitched whistling sound during breathing and occurs when air flows through narrowed breathing tubes, according to the US National Institutes of Health.
Rhinovirus is common cause of childhood asthma exacerbations.