BOSTON Jan 21 Giving steroids to children who
are wheezing because of viral or other infections does not
help, researchers reported on Wednesday.
And an experimental treatment designed to prevent wheezing
may be effective, but it seems to pose too many risks to be
recommended, according to studies published in the New England
Journal of Medicine.
About one-third of preschool children develop wheezing,
which can worry parents. At least 75 percent outgrow the
problem by age 6. In the past, doctors have treated it as they
would asthma, which is why they often use corticosteroids.
"It is clear that on the basis of these two studies,
current practice must change," Dr. Andrew Bush of the Imperial
School of Medicine and Royal Brompton Hospital in London wrote
in a commentary.
Dr. Jonathan Grigg of Queen Mary University in London and
colleagues found that children given five days of the steroid
prednisolone stayed just as long in hospital as children given
a placebo. They tested nearly 700 children aged 10 months to 5
Nor was there any difference in their symptoms over the
next seven days, Grigg's team reported.
"If your child is very sick, it doesn't mean you shouldn't
give oral steroids. But in the general run of things, for most
kids at home or presenting to their doctor with moderate
wheezing that doesn't require many days in the hospital,
steroids are not going to be of any benefit," Grigg said in a
"I would have loved for steroids to work," Grigg added.
However, he said, the result "does fit into the general
perception that preschool wheeze is very different from attacks
of allergic asthma in older children and adults."
Bush wrote: "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."
The second study compared GlaxoSmithKline's (GSK.N) (GSK.L)
Flovent, available generically as fluticasone, with a placebo
in 129 children aged 1 to 6 years. At the first sign of nasal
congestion, sore throat or other symptoms that might indicate
an upper respiratory tract infection, the children were treated
twice daily for up to 10 days.
The drug seemed to help, Dr. Francine Ducharme of the
Centre Hospitalier Universitaire in Montreal and colleagues
While 18 percent of the youngsters in the placebo group
needed further treatment with steroid drugs, the rate was 8
percent for those who got Flovent.
But the children who got Flovent tended to grow less -- a
tenth of an inch (one-third of a centimetre) less over nearly
10 months -- than those getting placebo.
"There is concern about patients overusing the drugs,"
Ducharme said in a telephone interview.
GlaxoSmithKline, which helped fund the study, released a
statement saying that the dose of Flovent was well above the
recommended range for treating asthma in children of that age,
and noting that the drug is not approved for treating wheezing.
However, the company said, "these results may help inform
future research efforts into viral-induced wheezing."
(Editing by Maggie Fox; editing by Mohammad Zargham)