January 22, 2009
Steroids May Be Harmful For Wheezing Children
New research suggests that steroid drugs, a common treatment for young children prone to wheezing and colds, do not help and may even be harmful.
Studies showed that preschoolers in Britain who were hospitalized with a wheezing attack and treated with the steroid prednisolone stayed just as long as other children who were given dummy pills.
Researchers said a separate study involving Canadian children who had previous wheezing trouble and took the steroid fluticasone as a preventive measure showed modest improvement, but the side effect of possible stunted growth outweighed the benefit.
The studies were published in Thursday's New England Journal of Medicine.
Dr. Andrew Bush of the Royal Brompton Hospital in London told the Associated Press it was disturbing to contemplate how many unnecessary courses of prednisolone had been given to preschool children over the years under the assumption that they were little adults.
Wheezing"”a high-pitched whistling noise as a person exhales"”is a condition that causes air to struggle through narrowed airways in the lungs, often prompting parents to take their children to emergency rooms because they assume their children can't breathe.
Steroids are often prescribed to children in order to open up air passages. However, for children who have asthma, its effectiveness on transient wheezing is debatable.
The university researchers kept tabs on 687 children ages 10 months to 5 years who were hospitalized for wheezing. The children were randomly put on prednisolone or placebo treatment.
The drug group spent 11 hours in the hospital, compared with 14 hours for the placebo group.
For the Canadian study group, 129 children between the ages of 1 and 6 years with a history of wheezing were given either inhaled fluticasone or placebo by their parents at the first sign of an infection.
The drug group showed milder symptoms and needed fewer repeat medications after 10 months. But researchers reported they also had smaller gains in height and weight compared with the placebo group, prompting the team to urge against using the drug for prevention purposes until the side effects were clearer.
GlaxoSmithKline PLC, which makes Flonase nasal spray, a brand of fluticasone, funded the study. Lead author Dr. Francine Ducharme of the University of Montreal reports receiving research grants from Glaxo and other drug makers.
The nonprofit Asthma UK paid for the British research. Several authors received fees and support from various drug makers that make asthma medication.
"The research gives us good information that what we've been doing doesn't work," said Dr. Bradley Chipps, an allergy specialist in Sacramento, Calif.
Chipps, a member of the allergy and immunology executive committee of the American Academy of Pediatrics, said the study gives the medical community a lead to pursue a safer alternative.
Wheezing children who do not have asthma will be better served by a wait-and-see approach, according to pediatrician Dr. Sami Bahna of the Louisiana State University Health Sciences Center in Shreveport.
"The majority will do well without intervention," Bahna said.
On the Net:
- New England Journal of Medicine
- Royal Brompton Hospital
- GlaxoSmithKline PLC
- University of Montreal
- American Academy of Pediatrics