January 22, 2009 10:55:29 am
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 per cent 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 years old.
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 telephone interview.
“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 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 reported.
While 18 per cent of the youngsters in the placebo group needed further treatment with steroid drugs,the rate was 8 per cent 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.”
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