Prednisolone reduces recurrent wheezing after first rhinovirus wheeze: a 7‐year follow‐up

Lukkarinen, Minna; Lukkarinen, Heikki; Lehtinen, Pasi; Vuorinen, Tytti; Ruuskanen, Olli; Jartti, Tuomas

BACKGROUND: To better understand the role of human rhinovirus‐associated wheeze as a risk factor for childhood recurrent wheezing, a cohort of young children experiencing their first wheezing episode was followed until school age. METHODS: All 111 hospitalized wheezing children (median age, 12 months) were initially participated in a randomized, double‐blind, placebo‐controlled, parallel trial on the efficacy of oral prednisolone. In this 7‐yr follow‐up, risk factors for recurrent wheezing were analysed, and then, the efficacy of prednisolone was evaluated overall and in pre‐specified subgroups post‐hoc. The main outcome was time to recurrent wheezing. RESULTS: The strongest independent risk factor for recurrent wheezing was rhinovirus detection (hazard ratio 3.54; 95% confidence interval 1.51–8.30) followed by sensitization (3.47; 1.55–8.30, respectively) age <1 yr (2.45; 1.29–4.65) and eczema (2.33; 1.11–4.90). Overall, prednisolone did not prevent recurrent wheezing. In subgroup analysis, prednisolone was associated with less recurrent wheezing in children affected by rhinovirus (0.32; 0.12–0.90, adjusted to sensitization, young age, viral aetiology and parental asthma) and/or with eczema (0.27; 0.08–0.87, adjusted respectively). CONCLUSIONS: Our data strengthen the role of rhinovirus‐associated wheeze as an important risk factor for recurrent wheezing and asthma in young first‐time wheezing children. Prospective randomized trials on the efficacy of corticosteroids in rhinovirus‐associated early wheezing are warranted. (ClinicalTrials.gov number, NCT 00494624)