Do oral corticosteroids reduce the severity of acute lower respiratory tract illnesses in preschool children with recurrent wheezing?

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• 作者：Avraham Beigelman ; MD ; MSCI^a ; ^{beigelman_a@kids.wustl.edu} ; Tonya S. King ; PhD^b ; David Mauger ; PhD^b ; Robert S. Zeiger ; MD ; PhD^c ; ^d ; Robert C. Strunk ; MD^a ; H. William Kelly ; PharmD^e ; Fernando D. Martinez ; MD^f ; Robert F. Lemanske Jr. ; MD^g ; Katherine Rivera-Spoljaric ; MD ; MSCI^a ; Daniel J. Jackson ; MD^g ; Theresa Guilbert ; MD^h ; Ronina Covar ; MDⁱ ; Leonard B. Bacharier ; MD^a ; Childhood Asthma Research ; Education Network of the National Heart ; Lung ; Blood Institute
• 关键词：Oral corticosteroids ; episodic wheezing ; preschool children
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：131
• 期：6
• 页码：1518-1525.e14
• 全文大小：1991 K

文摘

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Background

Oral corticosteroids (OCSs) are recommended for severe wheezing episodes in children. However, limited evidence supports this intervention in preschool children with outpatient wheezing illnesses.

Objective

We sought to investigate whether OCSs reduce symptom scores during acute lower respiratory tract illnesses (LRTIs) in preschool children with recurrent wheeze.

Methods

We performed post hoc and replication analyses in 2 outpatient cohorts of children aged 1 to 5 years with episodic wheezing participating in clinical trials. We compared symptom scores during LRTIs that were or were not treated with OCSs, adjusting for differences in disease and episode severity covariates. We stratified episodes by severity by using a propensity model. The primary outcome was the area under the curve (AUC) of total symptom scores among the more severe episodes.

Results

Two hundred fifteen participants from the Acute Intervention Management Strategies trial experienced 798 acute LRTIs, 112 of which were defined as severe based on propensity scores. The AUCs of total symptom scores did not differ between the episodes that were (n?=?70) and were not (n?=?42) treated with OCSs (P?=?.46) nor was there an OCS treatment effect on individual symptom scores. Similar analyses of the Maintenance Versus Intermittent Inhaled Corticosteroids in Wheezing Toddlers trial, involving 278 participants with 133 severe LRTIs, confirmed the above findings (P?=?.46 for AUC of total symptoms score comparison).

Conclusion

In 2 separate cohorts of preschool children with episodic wheezing, OCS treatment during clinically significant LRTIs did not reduce symptom severity during acute LRTIs, despite asthma controller medication use during most episodes. These findings need to be confirmed in a prospective randomized controlled trial.