Abstract
Acute rhinovirus-induced wheezing is common in young children and may respond to systemic corticosteroid. There are no trials on the efficacy of inhaled beta2 -agonist in this clinical scenario. To study post hoc the short-term (up to 2months) efficacy of inhaled beta2 -agonist with and without oral corticosteroid in the first acute rhinovirus-induced severe wheezing episode in young hospitalized children. The study population came from two randomized controlled trials comparing oral prednisolone (2mg/kg/d for 3days) to placebo: Vinku (n=35, NCT00494624) used high-dose regular nebulized salbutamol (0.15mg/kg 2-4h intervals) and Vinku2 (n=60, NCT00731575, EudraCT 2006-007100-42) used inhaled salbutamol on-demand. Both studies used identical detailed follow-up assessments. The primary outcome of the former was the duration of hospitalization and of the latter the occurrence of and the time to a new physician-confirmed wheezing episode within 2months after discharge. Treatment groups included salbutamol high-dose vs. salbutamol on-demand while adjusting for prednisolone status and acknowledging for interactions with exception of the duration of hospitalization in which prednisolone groups could not be fully used due to protocol differences. Median age of subjects was 13months, 32% were sensitized and 22% had doctor-diagnosed eczema. In the duration of hospitalization, salbutamol high-dose/placebo versus salbutamol on-demand/placebo groups did not differ (p=.12). In the occurrence of and time to relapse within 2months, a significant group×treatment interaction was observed (both p=.02), such that high-dose group had less and longer time to relapses than on-demand group in prednisolone arm (both p<.05), but no difference was detected in placebo arm (both p>.26). In young, hospitalized children with first episode of rhinovirus-induced wheezing, high-dose inhaled salbutamol may interact with oral prednisolone. However, further trials are warranted.
Highlights
Bronchiolitis affects up to 20%–30% of children during first two years of life and is the most common reason for hospitalization in children.[1]
In the occurrence of and time to relapse within 2 months, a significant group × treatment interaction was observed, such that high-dose group had less and longer time to relapses than on-demand group in prednisolone arm, but no difference was detected in placebo arm
In young, hospitalized children with first episode of rhinovirus-induced wheezing, high-dose inhaled salbutamol may interact with oral prednisolone
Summary
Bronchiolitis affects up to 20%–30% of children during first two years of life and is the most common reason for hospitalization in children.[1]. Objective: To study post hoc the short-term (up to 2 months) efficacy of inhaled beta2- agonist with and without oral corticosteroid in the first acute rhinovirus-induced severe wheezing episode in young hospitalized children. Methods: The study population came from two randomized controlled trials comparing oral prednisolone (2 mg/kg/d for 3 days) to placebo: Vinku (n = 35, NCT00494624) used high-dose regular nebulized salbutamol (0.15 mg/kg 2–4 h intervals) and Vinku[2] (n = 60, NCT00731575, EudraCT 2006-007100-42) used inhaled salbutamol on- demand. Both studies used identical detailed follow-up assessments. Treatment groups included salbutamol high-dose vs. salbutamol on-demand while adjusting for prednisolone status and acknowledging for interactions with exception of the duration of hospitalization in which prednisolone groups could not be fully used due to protocol differences
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