Prednisolone reduces recurrent wheezing after first rhinovirus wheeze: a 7-year follow-up

Abstract

Background: To better understand the role of human rhinovirus-associated wheeze as a risk factor for childhood recurrent wheezing, a cohort of young children experiencing their first wheezing episode was followed until school age.

Methods: All 111 hospitalized wheezing children (median age, 12 months) were initially participated in a randomized, double-blind, placebo-controlled, parallel trial on the efficacy of oral prednisolone. In this 7-yr follow-up, risk factors for recurrent wheezing were analysed, and then, the efficacy of prednisolone was evaluated overall and in pre-specified subgroups post-hoc. The main outcome was time to recurrent wheezing.

Results: The strongest independent risk factor for recurrent wheezing was rhinovirus detection (hazard ratio 3.54; 95% confidence interval 1.51-8.30) followed by sensitization (3.47; 1.55-8.30, respectively) age <1 yr (2.45; 1.29-4.65) and eczema (2.33; 1.11-4.90). Overall, prednisolone did not prevent recurrent wheezing. In subgroup analysis, prednisolone was associated with less recurrent wheezing in children affected by rhinovirus (0.32; 0.12-0.90, adjusted to sensitization, young age, viral aetiology and parental asthma) and/or with eczema (0.27; 0.08-0.87, adjusted respectively).

Conclusions: Our data strengthen the role of rhinovirus-associated wheeze as an important risk factor for recurrent wheezing and asthma in young first-time wheezing children. Prospective randomized trials on the efficacy of corticosteroids in rhinovirus-associated early wheezing are warranted. (ClinicalTrials.gov number, NCT 00494624).

Trial registration: ClinicalTrials.gov NCT00494624.

Figure 1

Study flow chart.

Figure 2

Risk of recurrent wheezing in prednisolone (bold line) and placebo recipients during a 7‐yr follow‐up. Prednisolone treatment was not associated with overall efficacy in preventing recurrent wheezing, but the treatment was associated with less recurrent wheezing in HRV and/or eczema group. In the HRV‐/RSV‐negative group, there were too few cases in prednisolone recipients with recurrent wheezing (n = 3) for statistical analysis. RSV, respiratory syncytial virus; HRV, human rhinovirus.