Prednisolone reduces recurrent wheezing after a first wheezing episode associated with rhinovirus infection or eczema

University of Turku, Turku, Varsinais-Suomi, Finland
Journal of Allergy and Clinical Immunology (Impact Factor: 11.48). 04/2007; 119(3):570-5. DOI: 10.1016/j.jaci.2006.11.003
Source: PubMed


Rhinovirus-induced early wheezing has been suggested as a new important risk factor for recurrent wheezing.
We sought to investigate the risk factors for recurrent wheezing and to determine post hoc the efficacy of prednisolone in risk groups.
We followed for 1 year 118 children (median age, 1.1 years) who had had their first episode of wheezing and had participated in a trial comparing prednisolone with placebo in hospitalized children. Demographics and laboratory data were obtained at study entry. The follow-up outcome was recurrent wheezing (3 physician-confirmed episodes).
Recurrent wheezing was diagnosed in 44 (37%) children. Independent risk factors were age < 1 year, atopy, and maternal asthma. The probability of recurrent wheezing was higher in rhinovirus than respiratory syncytial virus (RSV)-affected children among placebo recipients (hazard ratio, 5.05; 95% CI, 1.00-25.41). Prednisolone decreased the probability of recurrent wheezing in children with eczema (0.15; 95% CI, 0.04-0.63) but not in those without eczema (1.89; 95% CI, 0.83-4.29; P = .007 for interaction). Prednisolone was associated with less recurrent wheezing in the rhinovirus group (0.19; 95% CI, 0.05-0.71), but not in the RSV (2.12; 95% CI, 0.46-9.76) or in the RSV/rhinovirus-negative groups (2.03; 95% CI, 0.83-5.00; P = .017 for interaction).
Rhinovirus-induced early wheezing is a major viral risk factor for recurrent wheezing. Prednisolone may prevent recurrent wheezing in rhinovirus-affected first-time wheezers. The presence of eczema may also influence the response to prednisolone.
A prospective trial is needed to test the hypothesis that prednisolone reduces recurrent wheezing in rhinovirus-affected wheezing children.

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    • "However, the entry criterion for infants in our study was hospitalization for LRTI regardless of the presence of other risk factors for asthma, and only about a quarter of them had wheezing at hospitalisation. In contrast, previous studies in developed countries were conducted among children already at increased risk of asthma, since they either had presence of wheezing during LRTI [20–22] or parental history of asthma or respiratory allergies [23–26]. Information on family risk factors for asthma was not available in our study. "
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    ABSTRACT: Although association between respiratory syncytial virus infection and later asthma development has been established, little is known about the role of other respiratory viruses. Rhinovirus was considered a mild pathogen of the upper respiratory tract but current evidence suggests that rhinovirus is highly prevalent among children with lower respiratory tract infections (LRTI). The aim of the study was to evaluate whether LRTI hospitalization associated with rhinovirus during infancy was associated with an increased risk of wheezing - a proxy measure of asthma - during childhood. During a 12 months period, all infants <1 year admitted to Manhiça District Hospital with symptoms of LRTI who survived the LRTI episode, were enrolled in the study cohort. Nasopharyngeal aspirates were collected on admission for viral determination and study infants were classified according to presence or not of rhinovirus. The study cohort was passively followed-up at the Manhiça District Hospital for up to 4 years and 9 months to evaluate the association between LRTI associated with rhinovirus in infancy and wheezing during childhood. A total of 220 infants entered the cohort; 25% of them had rhinovirus detected during the LRTI episode as opposed to 75% who tested negative for rhinovirus. After adjusting for sex and age and HIV infection at recruitment, infants hospitalized with LRTI associated with rhinovirus had higher incidence of subsequent visits with wheezing within the year following hospitalization [Rate ratio=1.68, (95% confidence interval=1.02-2.75); Wald test p-value = 0.039]. No evidence of increased incidence rate of visits with wheezing was observed for the remaining follow-up period. Our data suggest a short term increased risk of wheezing after an initial episode of LRTI with RV.
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    • "For example, TTV and AdV infections are associated with a chronic inflammatory state of the lungs [15] [170] [171] [172] [173]. In children, there is a link between susceptibility to HRVinduced wheezing and the development of asthma [174] [175] [176] [177] [178], and in adults, HRV is the most important trigger of exacerbations of COPD [91] [95]. "
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    • "We based our study definition of recurrent wheezing, 1 or more dispensings of a short acting beta agonist in the previous 12 months and the absence of an asthma diagnosis, on the Advisory Committee on Immunization Practices (ACIP) recommended definition of 1 episode of asthma or wheezing in the previous 12 months. By definition, recurrent wheezing requires multiple episodes of wheezing and frequently in the medical literature a definition of 3 or more episodes is applied over a period of 6–12 months [6] [7] [8] [9] [10] [11] [12]. "
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