Level 1: Likely reliable evidence
Two recent studies investigated the use of corticosteroids for children with virus-induced asthma. Oral prednisolone was compared with placebo in a randomized trial involving 700 children aged 10-60 months who had mild-to-moderate wheezing (N Engl J Med. 2009;360:329-338). Prednisolone, 10 mg for children younger than 24 months and 20 mg for older children, was given once daily for five days. No significant differences were observed between groups in length of hospitalization, seven-day symptom scores, seven-day respiratory assessment scores, albuterol use, or adverse events.
Another randomized trial evaluated the use of intermittent high-dose fluticasone in 129 children aged 1-6 years with recurrent virus-induced asthma (N Engl J Med. 2009;360:339-353). Children received either 750 µg of fluticasone (in three inhalations) or placebo twice daily at the onset of upper respiratory tract infection and continuing until the child was free of cough and wheezing for 48 hours (up to a maximum of 10 days). At median follow-up of 40 weeks, children in the fluticasone group were significantly less likely to have required rescue systemic corticosteroids; infections in the fluticasone group lasted on average one day less than infections in the placebo group. Fluticasone was associated with slightly smaller mean gains in height and weight, but there were no significant differences in basal cortisol level, bone mineral density, or adverse events.
