open access

Vol 87, No 4 (2019)
ORIGINAL PAPERS
Published online: 2019-08-14
Submitted: 2019-03-07
Accepted: 2019-06-13
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Short course of systemic corticosteroids in wheezy children: still an open question

Valdone Miseviciene, Gintare Liakaite, Rimantas Kevalas
DOI: 10.5603/ARM.a2019.0035
·
Pubmed: 31476008
·
Adv Respir Med 2019;87(4):209-216.

open access

Vol 87, No 4 (2019)
ORIGINAL PAPERS
Published online: 2019-08-14
Submitted: 2019-03-07
Accepted: 2019-06-13

Abstract

Introduction: We performed a real-life clinical study to identify the main indications for the prescription of short-course treatment with systemic glucocorticosteroids (GCS) for steroid naive children with acute virus-induced wheezing as well as to analyze the influence of such treatment on patients’ serum cortisol level, other blood tests results and the length of stay in the hospital.
Material and methods: The data of 44 patients who had acute wheezing, had no bacterial infection and were otherwise healthy were analyzed: 26 children received treatment with GCS and 18 children did not. Full blood count, biochemistry tests (Na, K, glucose) and blood cortisol levels of all patients were analyzed during treatment.
Results: The main indications for the short-term administration of systemic GCS were increased work of breathing, recurrent wheezing, clinical signs of atopy and a family history of asthma. Systemic GCS increased a sodium concentration (p = 0.014), decreased a cortisol level (p = 0.038), leukocyte (p = 0.043), neutrophil (p = 0.045), and eosinophil (p < 0.001) count in blood serum. The major reduction in the eosinophil count was observed in allergic children (p = 0.023). Older age was a risk factor for cortisol suppression (p = 0.018). The average length of stay in the hospital was longer in the intervention group (p = 0.039).
Conclusion: Even short-course treatment with systemic GCS decreases the serum cortisol level and has a significant effect on other blood tests results. Systemic GCS used for acute virus-induced wheezing treatment did not prove to reduce the average length of stay in the hospital. Objective criteria for initiation of such treatment are still lacking, which might consequently lead to the overuse of corticosteroids.

Abstract

Introduction: We performed a real-life clinical study to identify the main indications for the prescription of short-course treatment with systemic glucocorticosteroids (GCS) for steroid naive children with acute virus-induced wheezing as well as to analyze the influence of such treatment on patients’ serum cortisol level, other blood tests results and the length of stay in the hospital.
Material and methods: The data of 44 patients who had acute wheezing, had no bacterial infection and were otherwise healthy were analyzed: 26 children received treatment with GCS and 18 children did not. Full blood count, biochemistry tests (Na, K, glucose) and blood cortisol levels of all patients were analyzed during treatment.
Results: The main indications for the short-term administration of systemic GCS were increased work of breathing, recurrent wheezing, clinical signs of atopy and a family history of asthma. Systemic GCS increased a sodium concentration (p = 0.014), decreased a cortisol level (p = 0.038), leukocyte (p = 0.043), neutrophil (p = 0.045), and eosinophil (p < 0.001) count in blood serum. The major reduction in the eosinophil count was observed in allergic children (p = 0.023). Older age was a risk factor for cortisol suppression (p = 0.018). The average length of stay in the hospital was longer in the intervention group (p = 0.039).
Conclusion: Even short-course treatment with systemic GCS decreases the serum cortisol level and has a significant effect on other blood tests results. Systemic GCS used for acute virus-induced wheezing treatment did not prove to reduce the average length of stay in the hospital. Objective criteria for initiation of such treatment are still lacking, which might consequently lead to the overuse of corticosteroids.

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Keywords

cortisol suppression, glucocorticosteroids, viral-induced wheezing, wheezing

About this article
Title

Short course of systemic corticosteroids in wheezy children: still an open question

Journal

Advances in Respiratory Medicine

Issue

Vol 87, No 4 (2019)

Pages

209-216

Published online

2019-08-14

DOI

10.5603/ARM.a2019.0035

Pubmed

31476008

Bibliographic record

Adv Respir Med 2019;87(4):209-216.

Keywords

cortisol suppression
glucocorticosteroids
viral-induced wheezing
wheezing

Authors

Valdone Miseviciene
Gintare Liakaite
Rimantas Kevalas

References (27)
  1. Fernandes RM, Oleszczuk M, Woods CR, et al. The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: an overview of reviews. Evid Based Child Health. 2014; 9(3): 733–747.
  2. de Benedictis FM, Bush A. Corticosteroids in respiratory diseases in children. Am J Respir Crit Care Med. 2012; 185(1): 12–23.
  3. Longui CA. Glucocorticoid therapy: minimizing side effects. J Pediatr (Rio J). 2007; 83(5 Suppl): S163–S177.
  4. McKay LI, Cidlowski JA. Physiologic and pharmacologic effects of corticosteroids. In: Kufe DE, Pollock RE, Weichselbaum RR et al. (ed.). Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON), BC Decker 2003.
  5. Kurukulaaratchy RJ, Fenn M, Twiselton R, et al. The prevalence of asthma and wheezing illnesses amongst 10-year-old schoolchildren. Respir Med. 2002; 96(3): 163–169.
  6. British Thoracic Society. British Thoracic Society and Scottish Intercollegiate Guidelines Network. British Guideline On The Management of Asthma. A National Clinical Guide 153. British Thoracic Society London: 107.
  7. Foster SJ, Cooper MN, Oosterhof S, et al. Oral prednisolone in preschool children with virus-associated wheeze: a prospective, randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2018; 6(2): 97–106.
  8. Beigelman A, Bacharier LB. Infection-induced wheezing in young children. J Allergy Clin Immunol. 2014; 133(2): 603–604.
  9. Beigelman A, Chipps BE, Bacharier LB. Update on the utility of corticosteroids in acute pediatric respiratory disorders. Allergy Asthma Proc. 2015; 36(5): 332–338.
  10. Panickar J, Lakhanpaul M, Lambert PC, et al. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med. 2009; 360(4): 329–338.
  11. National Institute for Health and Care Excellence (NICE). Bronchiolitis in children: diagnosis and management. NICE guideline 2015.
  12. Collins AD, Beigelman A. An update on the efficacy of oral corticosteroids in the treatment of wheezing episodes in preschool children. Ther Adv Respir Dis. 2014; 8(6): 182–190.
  13. Becker DE. Basic and clinical pharmacology of glucocorticosteroids. Anesth Prog. 2013; 60(1): 25–31; quiz 32.
  14. Chrousos G, Pavlaki AN, Magiakou MA, et al. Glucocorticoid therapy and adrenal suppression. [Updated 2011 jan 11]. In: de Groot LJ, Dungan K (ed.). . Endotext [Internet]. 2018.
  15. Alangari AA. Genomic and non-genomic actions of glucocorticoids in asthma. Ann Thorac Med. 2010; 5(3): 133–139.
  16. Average Increases in White Blood Cell (WBC) Counts with Glucocorticoids (e.g., Decamethasone, Methylprednisolone, and Prednisone). [Internet]. Ebmconsult.com. 2015 [cited 30 August, 2017]. Avaiable from: www.ebmconsult.com/articles/glucocorticoid-wbc-increase-steroids.
  17. Riley LK, Rupert J. Evaluation of patients with leukocytosis. Am Fam Physician. 2015; 92(11): 1004–1011.
  18. Zimmerman JJ. Adjunctive steroid therapy for treatment of pediatric septic shock. Pediatr Clin North Am. 2017; 64(5): 1133–1146.
  19. Kim CK, Callaway Z, Fujisawa T. Infection, eosinophilia and childhood asthma. Asia Pac Allergy. 2012; 2(1): 3–14.
  20. Arkader R, Malbouisson LM, Del Negro GM, et al. Factors associated with hyperglycemia and low insulin levels in children undergoing cardiac surgery with cardiopulmonary bypass who received a single high dose of methylprednisolone. Clinics (Sao Paulo). 2013; 68(1): 85–92.
  21. Wintergerst KA, Foster MB, Sullivan JE, et al. Association of hyperglycemia, glucocorticoids, and insulin use with morbidity and mortality in the pediatric intensive care unit. J Diabetes Sci Technol. 2012; 6(1): 5–14.
  22. Tarjányi Z, Montskó G, Kenyeres P, et al. Free and total cortisol levels are useful prognostic markers in critically ill patients: a prospective observational study. Eur J Endocrinol. 2014; 171(6): 751–759.
  23. Ballestero Y, López-Herce J, González R, et al. Relationship between hyperglycemia, hormone disturbances, and clinical evolution in severely hyperglycemic post surgery critically ill children: an observational study. BMC Endocr Disord. 2014; 14: 25.
  24. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013; 9(1): 30.
  25. Guaraldi F, Karamouzis I, Berardelli R, et al. Secondary adrenal insufficiency: where is it hidden and what does it look like? Front Horm Res. 2016; 46: 159–170.
  26. Auron M, Raissouni N. Adrenal insufficiency. Pediatr Rev. 2015; 36(3): 92–102; quiz 103, 129.
  27. Ahmet A, Brienza V, Tran A, et al. Frequency and duration of adrenal suppression following glucocorticoid therapy in children with rheumatic diseases. Arthritis Care Res (Hoboken). 2017; 69(8): 1224–1230.

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