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THE USE OF STEROIDS IN CHILDHOOD ASTHMA BEFORE WHEEZING OCCURS.

In preschool children, asthma is commonly precipitated by a viral upper respiratory tract infection (URI). These authors evaluated the efficacy of short-term steroid treatment in preventing URI-induced asthma. Two groups (of 16 children each) with a history of at least four severe attacks and two hospitalizations per year were prospectively studied for two consecutive years. All children received standard therapy (theophylline and oral metaproterenol) for both years; however, during the second year, one group received prednisone (1 mg/kg/day for 7 to 14 days) at the first appearance of URI and before any sign of wheezing. None of the children used inhaled beta-adrenergic agonists at home.

In the prednisone group, the incidence of attacks and the number of days of wheezing was reduced by more than 50 percent during the year of prednisone therapy. In addition, there was a 61 percent reduction in the number of emergency room visits and a 90 percent reduction in the number of hospitalizations. In the control group there was no significant difference between the two years in any of these factors.

The authors conclude in this pilot study that early steroid therapy reduces the severity of disease; the benefit of giving steroids once an attack begins is controversial. Because daily short-term use of steroids carries little risk of serious toxicity, such therapy appears to be safe and effective in preventing URI-induced acute exacerbations of asthma in preschool children with a history of severe disease.

— PMM

Published in Journal Watch General Medicine May 17, 1988

Citation(s):

Brunette M G; Lands L; Thibodeau L P. Childhood asthma: prevention of attacks with short- term corticosteroid treatment of upper respiratory tract infection. Pediatrics 1988 May 81 624-629.

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