Babies and children * Allergies and hay fever

Steroids ineffective in young children with wheeze

Steroids dont work for non-asthma wheezing Research investigates the use of steroids in treating wheezing in pre-school children

New research, funded by the charity Asthma UK, has found that steroid tablets do not reduce the symptoms of virus-induced wheezing in pre-school children.

Previously, doctors have been undecided on the best way to treat pre-school children admitted to hospital with severe wheezing caused by an infection such as a virus.

Steroids are an important part of treatment for children with asthma. However, pre-school children with viral-induced wheeze, where symptoms are associated with colds or flu and do not persist when the child is not infected with a virus, have also been treated with steroids in the past. According to the results of this study, steroid tablets do not help these children.

This research, carried out by Professor Jonathan Grigg (Barts and the London School of Medicine and Dentistry), involved 700 children between the age of 10 months and 5 years, all of whom were hospitalised due to a severe bout of wheezing.

Half the children were given a 5-day course of steroid tablets and the other half were given a placebo (dummy pill). The researchers found that children given steroid pills stayed in hospital just as long, required the same amount of treatment, and had as many symptoms as children given the placebo pills.

Almost all of the children in the study had not been diagnosed as having asthma. The study adds to evidence that suggests that there are different patterns of wheezing in young children requiring different treatments.

Currently, the link between pre-school wheezing and asthma development is unclear. It is not known whether a viral infection which can cause wheezing in young children demonstrates a susceptibility to asthma, or whether the virus itself causes damage which then leads to asthma developing.

Professor Jonathan Grigg says: ‘Wheeze in young children is, in many ways, very different from wheeze in older children and adults. We urgently need high quality research to investigate how best to treat young children who only wheeze in response to viral infections and to find ways of identifying the minority of wheezy pre-school children who will go on to develop asthma.’

Dr Mike Thomas, Chief Medical Advisor for Asthma UK, says: ‘This study is well done and the findings are robust. Dr Grigg’s research shows that the current practice of giving oral steroids to children admitted to hospital with wheezing associated with a viral infection is not helpful, and this could have important implications for the medical community.

‘Young children who only get wheezy when they have a cold or viral chest infection but can breathe normally at other times, are likely to grow-out of their tendency to wheeze by teenage years. It is important that we stop relying on a one-solution-fits-all which means that these young children are taking steroids unnecessarily, and to search for more effective treatments for these children.’

Asthma UK emphasises that anyone concerned about their child’s medicines should discuss it with their doctor or asthma nurse before making any changes to their child's treatment.

This article was published on Fri 23 January 2009

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