Efficacy of inhaled salbutamol with and without prednisolone for first acute rhinovirus-induced wheezing episode

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Hurme , P , Homil , K , Lehtinen , P , Turunen , R , Vahlberg , T , Vuorinen , T , Camargo , C A J J , Gern , J E & Jartti , T 2021 , ' Efficacy of inhaled salbutamol with and without prednisolone for first acute rhinovirus-induced wheezing episode ' , Clinical and Experimental Allergy , vol. 51 , no. 9 , pp. 1121-1132 . https://doi.org/10.1111/cea.13960

Title: Efficacy of inhaled salbutamol with and without prednisolone for first acute rhinovirus-induced wheezing episode
Author: Hurme, Pekka; Homil, Kiara; Lehtinen, Pasi; Turunen, Riitta; Vahlberg, Tero; Vuorinen, Tytti; Camargo, Carlos A. Jr Jr; Gern, James E.; Jartti, Tuomas
Contributor organization: Faculty of Medicine
University of Helsinki
HUS Children and Adolescents
Children's Hospital
Date: 2021-09
Language: eng
Number of pages: 12
Belongs to series: Clinical and Experimental Allergy
ISSN: 0954-7894
DOI: https://doi.org/10.1111/cea.13960
URI: http://hdl.handle.net/10138/340479
Abstract: Background Acute rhinovirus-induced wheezing is common in young children and may respond to systemic corticosteroid. There are no trials on the efficacy of inhaled beta(2)-agonist in this clinical scenario. Objective To study post hoc the short-term (up to 2 months) efficacy of inhaled beta(2)-agonist with and without oral corticosteroid in the first acute rhinovirus-induced severe wheezing episode in young hospitalized children. Methods The study population came from two randomized controlled trials comparing oral prednisolone (2 mg/kg/d for 3 days) to placebo: Vinku (n = 35, NCT00494624) used high-dose regular nebulized salbutamol (0.15 mg/kg 2-4 h intervals) and Vinku2 (n = 60, NCT00731575, EudraCT 2006-007100-42) used inhaled salbutamol on-demand. Both studies used identical detailed follow-up assessments. The primary outcome of the former was the duration of hospitalization and of the latter the occurrence of and the time to a new physician-confirmed wheezing episode within 2 months after discharge. Treatment groups included salbutamol high-dose vs. salbutamol on-demand while adjusting for prednisolone status and acknowledging for interactions with exception of the duration of hospitalization in which prednisolone groups could not be fully used due to protocol differences. Results Median age of subjects was 13 months, 32% were sensitized and 22% had doctor-diagnosed eczema. In the duration of hospitalization, salbutamol high-dose/placebo versus salbutamol on-demand/placebo groups did not differ (p = .12). In the occurrence of and time to relapse within 2 months, a significant group x treatment interaction was observed (both p = .02), such that high-dose group had less and longer time to relapses than on-demand group in prednisolone arm (both p < .05), but no difference was detected in placebo arm (both p > .26). Conclusions In young, hospitalized children with first episode of rhinovirus-induced wheezing, high-dose inhaled salbutamol may interact with oral prednisolone. However, further trials are warranted.
Subject: Asthma
beta(2)-agonist
bronchiolitis
corticosteroid
paediatrics
virus
RESPIRATORY SYNCYTIAL VIRUS
ALLERGIC SENSITIZATION
CLINICAL SPECIMENS
BRONCHIOLITIS
ASTHMA
CHILDREN
PCR
ENTEROVIRUSES
INFECTIONS
GUIDELINES
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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