Parent-initiated oral corticosteroid therapy for intermittent wheezing illnesses in children: systematic review

AIM: Intermittent wheezing illnesses, which include viral-associated wheeze and asthma, are among the most common reasons for children to present urgently to a doctor. The objectives of this systematic review were to assess the benefits and harmful effects of parent-initiated oral corticosteroids (PIOCS) in the management of intermittent wheezing illness in children. METHODS: The Cochrane Airways Group Specialised Register, The Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE, LILACS, Web of Science and Dissertation Abstracts were searched. Only randomised clinical trials studying patients aged between 1 and 18 years, with an intermittent wheezing illness were included. RESULTS: From 572 original citations, a total of two randomised clinical trials (303 randomised participants) were included. The quality of the included trials was high; however, marked clinical heterogeneity precluded a meta-analysis. The two trials did not find evidence that PIOCS are associated with a benefit in terms of hospital admissions, unscheduled medical reviews, symptoms scores, or bronchodilator use. CONCLUSION: Limited current evidence is available and it is inconclusive regarding the benefit from PIOCS therapy in the treatment of intermittent wheezing illnesses in children. Oral corticosteroids have a clearly defined role in the management of acute asthma in the hospital setting. Therefore, it is reasonable for clinicians to recommend PIOCS when (i) the child has a history of severe acute asthma; and (ii) the parents are able to assess asthma status. However, widespread use of PIOCS cannot be recommended until the benefits and harms can be clarified further.