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Clinical Trial
. 2007 Mar;119(3):570-5.
doi: 10.1016/j.jaci.2006.11.003. Epub 2006 Dec 27.

Prednisolone reduces recurrent wheezing after a first wheezing episode associated with rhinovirus infection or eczema

Pasi Lehtinen  1 , Aino Ruohola, Timo Vanto, Tytti Vuorinen, Olli Ruuskanen, Tuomas Jartti
Affiliations
Clinical Trial

Prednisolone reduces recurrent wheezing after a first wheezing episode associated with rhinovirus infection or eczema

Pasi Lehtinen et al. J Allergy Clin Immunol. 2007 Mar.

Abstract

Background: Rhinovirus-induced early wheezing has been suggested as a new important risk factor for recurrent wheezing.

Objective: We sought to investigate the risk factors for recurrent wheezing and to determine post hoc the efficacy of prednisolone in risk groups.

Methods: We followed for 1 year 118 children (median age, 1.1 years) who had had their first episode of wheezing and had participated in a trial comparing prednisolone with placebo in hospitalized children. Demographics and laboratory data were obtained at study entry. The follow-up outcome was recurrent wheezing (3 physician-confirmed episodes).

Results: Recurrent wheezing was diagnosed in 44 (37%) children. Independent risk factors were age < 1 year, atopy, and maternal asthma. The probability of recurrent wheezing was higher in rhinovirus than respiratory syncytial virus (RSV)-affected children among placebo recipients (hazard ratio, 5.05; 95% CI, 1.00-25.41). Prednisolone decreased the probability of recurrent wheezing in children with eczema (0.15; 95% CI, 0.04-0.63) but not in those without eczema (1.89; 95% CI, 0.83-4.29; P = .007 for interaction). Prednisolone was associated with less recurrent wheezing in the rhinovirus group (0.19; 95% CI, 0.05-0.71), but not in the RSV (2.12; 95% CI, 0.46-9.76) or in the RSV/rhinovirus-negative groups (2.03; 95% CI, 0.83-5.00; P = .017 for interaction).

Conclusion: Rhinovirus-induced early wheezing is a major viral risk factor for recurrent wheezing. Prednisolone may prevent recurrent wheezing in rhinovirus-affected first-time wheezers. The presence of eczema may also influence the response to prednisolone.

Clinical implications: A prospective trial is needed to test the hypothesis that prednisolone reduces recurrent wheezing in rhinovirus-affected wheezing children.

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Figures

Fig 1
Fig 1
Study flow chart.
Fig 2
Fig 2
Probability of recurrent wheezing in prednisolone (bold line) and placebo recipients during a 1-year follow-up (censored cases marked with vertical lines).
See this image and copyright information in PMC

Comment in

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