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Steroids Questioned for Wheezing Children

Jan 22, 2009 | Parker Waichman LLP Prescribing steroids to children with so-called transient wheezing seems to offer more risks than benefits according to two emerging studies.  Steroid treatment for wheezing children with viral or other infections, is not effective, according to researchers, reported Reuters.

Reuters also noted that, in addition, an experimental treatment for the prevention of wheezing, while possibly effective, has proven too risky and cannot be recommended.  Bloomberg News said the risks involved include, among other side effects, stunted growth.  US News & World Report’s HealthDay said that steroids performed no better than placebos in toddlers whose wheezing was from colds.  The studies were published in the New England Journal of Medicine.

While about one-third of preschoolers will suffer from wheezing, most—about 75 percent—outgrow this by the time they are six years of age, said Reuters, which explained that, until now, doctors treated wheezing in the same way as they would treat asthma:  With corticosteroids.   "It is clear that on the basis of these two studies, current practice must change," said Dr. Andrew Bush of the Imperial School of Medicine and Royal Brompton Hospital in London, quoted Reuters.

HealthDay reported that both studies looked at over 800 children, one-to-six years of age, who were admitted to the hospital for wheezing.  One study was led by British researchers and looked at 687 children who were randomly prescribed either the steroid prednisolone or a placebo.  The difference in hospital stay time was considered relatively insignificant said HealthDay:  Children prescribed the steroid spent 11 hours, while children dosed with a placebo spent 14 hours in the hospital.  Also, Reuters reported that Dr. Jonathan Grigg of Queen Mary University in London and his team revealed that those children who received five days of prednisolone not only experienced similar hospital stays as children who were prescribed a placebo, the symptoms between the two groups were not significantly different.

Grigg told Rueters that, “preschool wheeze is very different from attacks of allergic asthma in older children and adults" and Reuters quoted Bush as saying that steroid treatment in young children with wheeze is not needed.  "It is disturbing to contemplate how many unnecessary courses of prednisolone have been given over the years, in good faith, because we all assumed that preschool children are little adults," said Bush.

In the second study, said HealthNews, 129 children received the inhaled steroid Flovent—(generic:  fluticasone)—or a placebo when they first showed symptoms of illness.  The children were treated twice daily for 10 days, said Reuters.  After 10 months, the Canadian researchers found those taking Flovent exhibited less severe symptoms and did not require as many repeat dosings; however, they also exhibited reduced weight and height gains.  Because of this, researchers warn that use of Flovent in children should be discouraged for now, reported HealthDay.

Bush concluded, reported Bloomberg that, “There can no longer be any justification” for giving steroid pills to wheezing preschoolers who don’t have asthma unless doctors think the child’s condition is severe….  It is disturbing to contemplate how many unnecessary courses of prednisolone have been given over the years, in good faith, because we all assumed that preschool children are little adults.”

Children are typically treated with steroids—which are generally prescribed for adult and pediatric asthmatics—to open up airways; however, steroid efficacy in the treatment of “transient” wheezing in children remains unknown, said HealthDay.

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