PT  - JOURNAL ARTICLE
AU  - Alexandra Wallace
AU  - Owen Sinclair
AU  - Michael Shepherd
AU  - Jocelyn Neutze
AU  - Adrian Trenholme
AU  - Eunicia Tan
AU  - Christine Brabyn
AU  - Megan Bonisch
AU  - Naomi Grey
AU  - David W Johnson
AU  - David McNamara
AU  - John M D Thompson
AU  - Innes Asher
AU  - Stuart R Dalziel
TI  - Impact of oral corticosteroids on respiratory outcomes in acute preschool wheeze: a randomised clinical trial
AID  - 10.1136/archdischild-2020-318971
DP  - 2021 Apr 01
TA  - Archives of Disease in Childhood
PG  - 339--344
VI  - 106
IP  - 4
4099  - http://adc.bmj.com/content/106/4/339.short
4100  - http://adc.bmj.com/content/106/4/339.full
SO  - Arch Dis Child2021 Apr 01; 106
AB  - Objective To determine if administration of oral prednisolone to preschool children with acute wheeze alters respiratory outcomes.Design Double-blind, randomised, placebo-controlled equivalence trial.Setting Three hospitals in New Zealand.Patients 477 children aged 24–59 months with acute wheeze associated with respiratory illness.Interventions 2 mg/kg (maximum 40 mg) oral prednisolone or similar placebo, once daily for 3 days.Main outcome measures Primary outcome was change in Preschool Respiratory Assessment Measure (PRAM) score 24 hours after intervention. Secondary outcomes included PRAM score at 4 hours, length of emergency department and inpatient stays, admission and representation rates, time to return to normal activities and use of additional oral prednisolone or intravenous medications. Analysis was by intention-to-treat.Results There was no difference between groups for change in PRAM score at 24 hours (difference between means −0.39, 95% CI −0.84 to 0.06, p=0.09). Absolute PRAM score was lower in the prednisolone group at 4 hours (median (IQR) 1 (0–2) vs 2 (0–3), p=0.01) and 24 hours (0 (0–1) vs 0 (0–1), p=0.01), when symptoms had resolved for most children regardless of initial treatment. Admission rate, requirement for additional oral prednisolone and use of intravenous medication were lower in the prednisolone group, although there were no differences between groups for time taken to return to normal activities or rates of representation within 7 days.Conclusion Oral prednisolone does not alter respiratory outcomes at 24 hours or beyond in preschool children presenting with acute wheeze.