Giving Preschoolers Steroids for Wheezing is Not Effective and Can Be Harmful

I worked with children for a long time. Watching three-year olds get medication for Attention Deficit Disorder was hard enough. Reading that young children have been and still are being given steroids for upper respiratory viral infections is appalling. Now the New England Journal of Medicine has published a study showing that in fact these steroids don't help!

What doctors have been giving children as young as ten months old and especially through the age of six is prednisone. Viral infections are common in these little kids and when they show up at the doctor or hospital oral prednisone has been given. The common symptom is wheezing.

A scientific study (From the Division of Child Health (J.P., M.L., P.K.) and the Centre for Biostatistics and Genetic Epidemiology, Department of Health Sciences (P.C.L.), University of Leicester, Leicester; the Division of Child Health, University of Nottingham, University Hospital Queen's Medical Centre, Nottingham (T.S., A.S.); and the Centre for Paediatrics, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London (J.G.) was done using a random group of children. It was a double blind (meaning the researchers did not know which group was getting the oral prednisone and which one was not) five day course of 10 mg once a day for kids 10 to 24 months and 20 mg once a day for older children. A placebo was given to the other half of the 700 children who showed up in hospitals in England. To be totally accurate 343 kids were treated with prednisone and 344 in the placebo group. The researchers were looking at how long the kids would have to stay in the hospital and also a measurement that included a score of symptoms.

The results showed that there was not a statistically significant difference in the time the kids spent in the hospital no matter which group they had been place in.

The kids taking the prednisone were in for a little less than 14 hours. The kids in the placebo group stayed for 11 hours. In research this is called not statistically significant.

There was also no significant difference between the measurement outcomes I mentioned above between the two groups. The conclusion is that giving these steroids which have a lot of side effects for all ages is not worth it.

The New England Journal of Medicine also reported another study which found that when parents gave Flovent, an inhaled steroid made by GlaxoSmithKline, to their preschoolers who were showing the same symptom as above - wheezing - they were less likely to go to the hospital after their symptoms got worse. 129 children with a history of developing asthma symptoms when they got colds were followed. They had been hospitalized at least once. Eight percent of the kids who had been given Flovent ended up in the hospital and later given oral steroids compared with 18% of the kids who inhaled a placebo. .

It's clear that the more benign inhaled steroid was not only more effective but perhaps less toxic since it wasn't taken orally. Obviously children with severe cases of asthma would be treated with oral prednisone. Now when it comes to older kids and adults it seems that giving them oral steroids is effective and is the treatment of choice.

Source

New England Journal of Medicine