Oral prednisolone during hospitalisation reduced clinical symptoms and shortened hospital length of stay in select groups.

For preschool children (age range, 1 to 5 years) who present with wheezing in the acute care setting, clinicians often must make challenging decisions on whether to treat them with oral corticosteroids. Placebo-controlled trials have yielded discordant results about the effectiveness of corticosteroids, which has discouraged a unified treatment approach.

In this meta-analysis, researchers analysed individual participant-level data from seven placebo-controlled, randomised trials. A total of 1728 preschool children who presented to the hospital with wheezing received oral prednisolone (the corticosteroid used in each of the trials) or placebo. Results for children who received oral prednisolone, versus those who received placebo, were as follows:

• meaningfully lower wheezing severity score at four hours; greatest difference for children with moderate-to-severe wheezing (compared with the subgroup who had mild wheezing)
• shorter hospital length of stay (by three hours); greatest difference for children with previous wheezing or diagnosed asthma
• a higher, but nonsignificant, risk for vomiting.

Comment: Even 15 years into practice, I still find the decision vexing about whether to treat a wheezing child with steroids: will corticosteroids help? Or am I unnecessarily exposing the child to side effects and contributing to overuse? These meta-analysis results add parameters to the clinical instincts many of us have: for a child with moderate-to-severe wheezing or a history of wheezing or asthma, corticosteroids reduce clinical symptoms and shorten subsequent length of stay.

James A. Feinstein, MD, MPH, Associate Professor of Pediatrics, Children’s Hospital Colorado and University of Colorado School of Medicine, Denver, USA.

Lee B, et al. Efficacy of oral corticosteroids for acute preschool wheeze: a systematic review and individual participant data meta-analysis of randomised clinical trials. Lancet Respir Med 2024; 12: 444-456.

Makrinioti H. Oral corticosteroids for acute preschool wheeze. Lancet Respir Med 2024; 12: 421-422.

This summary is taken from the following Journal Watch title: Pediatrics and Adolescent Medicine.