Steroids ineffective in young children with wheeze
22 January 2009

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

There has been ongoing controversy in the medical community regarding how to best treat pre-school children who are admitted to hospital with severe wheezing.

Steroids remain an important treatment for children with asthma but pre-school children with viral-induced wheeze, where symptoms are only 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.

This trial definitively shows that steroid tablets do not help these children.

This study, conducted 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 in hospital due to a severe episode of wheezing. Half were given a 5-day course of steroid tablets and the other half were given a placebo.

The researchers found that the children who received the steroid pills needed to stay in hospital just as long, needed the same amount of treatment, and had as many symptoms, as the children who received the placebos.

Most of the children in this study had not been diagnosed as having asthma, and the study adds to evidence that there are different patterns of wheezing in young children which require different treatments.

The link between pre-school wheezing and asthma is unclear and it is not yet known whether a viral infection which causes wheezing in young children demonstrates a susceptibility to asthma, or whether it causes damage which then leads to asthma developing. Distinguishing between asthma and viral-induced wheeze in pre-school children is often difficult, and there is a pressing need for greater understanding of the differences, so that treatments can be targeted appropriately.

Asthma UK is funding a number of research projects to investigate childhood asthma and wheezing, which we hope will play an important role in improving the care these children receive. If you are concerned about your child’s medicines it is important that you discuss your worries with your doctor or asthma nurse before you make any changes to their treatment.

Professor Jonathan Grigg said: ‘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, said: ‘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.’