High oral corticosteroid use during acute attacks of preschool wheeze irrespective of clinical phenotype
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Objective: This study aims to evaluate the burden of oral corticosteroid (OCS) use and any relationship to clinical phenotype in preschool children presenting with acute wheeze attacks.
Methods: Single centre prospective study in which children with recurrent, severe preschool wheeze (PSW) who were referred to a tertiary respiratory centre, had symptom questionnaire, point-of-care blood eosinophil count (BEC) and aeroallergen sensitisation tests, undertaken on the same day as their outpatient clinic appointment.
Results: 100 children with PSW (median age 3.5 years; interquartile range (IQR) 2.8-4.9 years; 51% male) were recruited. Clinical atopy, based on parental reporting, was present in 42%, while objective sensitisation, confirmed by testing, was observed in 35%. Median lifetime OCS courses per child was 10 (IQR 6-18), and 5 (IQR 3-7) during the preceding 12 months. Regardless of which definition of atopy was used, atopic children had higher BEC when well, compared to non-atopic children: using clinical atopy classification, median BEC was 0.65 vs 0.3×10⁹/L, (p=0.003) and using objective atopy, median BEC was 0.7 vs 0.3 ×10⁹/L, (p<0.0001). There was no difference in the use of OCS in the acute setting between higher and lower BEC, between clinical or objective atopy, or a combination of these, either over the child’s lifetime or during the previous 12 months.
Conclusion: Children with severe, recurrent PSW are being treated with large numbers of OCS courses despite the lack of evidence of significant efficacy. There is an urgent need for trials which include phenotyping of acute attacks to guide OCS treatment.
Methods: Single centre prospective study in which children with recurrent, severe preschool wheeze (PSW) who were referred to a tertiary respiratory centre, had symptom questionnaire, point-of-care blood eosinophil count (BEC) and aeroallergen sensitisation tests, undertaken on the same day as their outpatient clinic appointment.
Results: 100 children with PSW (median age 3.5 years; interquartile range (IQR) 2.8-4.9 years; 51% male) were recruited. Clinical atopy, based on parental reporting, was present in 42%, while objective sensitisation, confirmed by testing, was observed in 35%. Median lifetime OCS courses per child was 10 (IQR 6-18), and 5 (IQR 3-7) during the preceding 12 months. Regardless of which definition of atopy was used, atopic children had higher BEC when well, compared to non-atopic children: using clinical atopy classification, median BEC was 0.65 vs 0.3×10⁹/L, (p=0.003) and using objective atopy, median BEC was 0.7 vs 0.3 ×10⁹/L, (p<0.0001). There was no difference in the use of OCS in the acute setting between higher and lower BEC, between clinical or objective atopy, or a combination of these, either over the child’s lifetime or during the previous 12 months.
Conclusion: Children with severe, recurrent PSW are being treated with large numbers of OCS courses despite the lack of evidence of significant efficacy. There is an urgent need for trials which include phenotyping of acute attacks to guide OCS treatment.
Date Acceptance
2026-07-31
Citation
Archives of Disease in Childhood
ISSN
0003-9888
Publisher
BMJ Publishing Group
Journal / Book Title
Archives of Disease in Childhood
Copyright Statement
Copyright This paper is embargoed until publication. Once published the author’s accepted manuscript will be made available under a CC-BY License in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy).
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Publication Status
Accepted