Steroids ineffective in young children with wheeze

Feb 23 2009

New research involving medical experts at The University of Nottingham has found that steroid tablets do not reduce the symptoms of virus-induced wheezing in pre-school children.

Researchers from the universities of Nottingham, Leicester and Bart's in London have been at the centre of a leading study to find out whether steroid medicine will relieve wheezing symptoms in children under five years of age.

There has been ongoing controversy in the medical community regarding how to best treat pre-school children who are admitted to hospital with severe wheezing. Steroids remain an important treatment for children with asthma but pre-school children with viral-induced wheeze, where symptoms are only associated with colds or flu and do not persist when the child is not infected with a virus, have also been treated with steroids in the past. This trial, funded by Asthma UK and published in the New England Journal of Medicine, definitively shows that steroid tablets do not help these children.

The research was carried out by Dr Alan Smyth, Associate Professor and Reader in Child Health, and Terence Stephenson, Professor of Child Health, at The University of Nottingham in collaboration with Dr Monica Lakhanpaul, Senior Lecturer from the University of Leicester and Consultant Paediatrician in Children's Community Health Service for Leicester, Leicestershire and Rutland and Professor Jonathan Grigg of Barts and the London School of Medicine and Dentistry.

Dr Alan Smyth said: "There may be some children - for example those with a family history of asthma - who benefit. However, young children who wheeze when they have a viral infection, do not seem to be helped by steroids."

Dr Monica Lakhanpaul added: "A number of treatments are used in children without strong evidence. This study demonstrates the need for further research in children not only to help us to find out treatments that work but also those that do not work which will then open the way to new research. It is sometimes difficult to recruit children to research studies but this study has been strongly supported by the families and children in the East Midlands and will help us to move another step closer to helping those children who suffer from wheeze."

Dr Mike Thomas, Chief Medical Advisor for Asthma UK, welcomed the study, which he said could have important implications for the medical community.

"Young children who only get wheezy when they have a cold or viral chest infection but can breathe normally at other times, are likely to grow-out of their tendency to wheeze by teenage years. It is important that we stop relying on a one-solution-fits-all which means that these young children are taking steroids unnecessarily, and to search for more effective treatments for these children," he added.