RT Journal Article
SR Electronic
T1 Impact of oral corticosteroids on respiratory outcomes in acute preschool wheeze: a randomised clinical trial
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 339
OP 344
DO 10.1136/archdischild-2020-318971
VO 106
IS 4
A1 Alexandra Wallace
A1 Owen Sinclair
A1 Michael Shepherd
A1 Jocelyn Neutze
A1 Adrian Trenholme
A1 Eunicia Tan
A1 Christine Brabyn
A1 Megan Bonisch
A1 Naomi Grey
A1 David W Johnson
A1 David McNamara
A1 John M D Thompson
A1 Innes Asher
A1 Stuart R Dalziel
YR 2021
UL http://adc.bmj.com/content/106/4/339.abstract
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.