Do not routinely use systemic corticosteroids in episodic wheezing in kids- Case Report

Do not routinely use systemic corticosteroids in episodic wheezing in kids, suggests a case study.

A case of a 4 years old girl presented at the emergency department with wheezing, tachypnea, and respiratory distress who received systemic corticosteroids that probably deteriorated her condition, was reported in the Journal of Hospital Medicine.

The case presented in the journal raises a few important questions regarding the application of systemic corticosteroids in pre-school children.

Wheezing is quite common with pre-school children. Young children with wheezing require ED visits and hospitalizations at much higher rates than older children and adults. Several studies have also demonstrated that children in this age group have higher rates of systemic corticosteroids prescriptions compared with older children.

Systemic corticosteroid is the standard of care for an acute asthma exacerbation. Studies of oral corticosteroid use in children with asthma have shown adverse side- effects including vomiting, hypertension, and impaired growth. Children with recurrent wheeze receiving systemic corticosteroids may demonstrate biochemical hypothalamic-pituitary-axis dysfunction.

Taking a note from the results of past research and in this situation, the authors of the case- study have proposed recommendations that could help the physician to make the correct decision.

• Do not routinely treat with systemic corticosteroids preschool-aged children who have episodic wheezing triggered by viral respiratory tract infections and who do not have risk factors for persistent asthma.


• For preschool-aged children with a history of atopy, a positive API, or elevated PARS, systemic corticosteroids can be considered during admissions for respiratory distress and wheezing.


• Preschool-aged children presenting with severe disease or requiring intensive care may benefit from SCS, but there is insufficient evidence to conclude whether this practice provides benefit.

Summing up the authors concluded that "current evidence does not support the routine use of systemic corticosteroids for preschool-aged children admitted for mild to moderate wheezing episodes. The majority of these children have viral episodic wheeze that does not develop into the asthma phenotype. For children with severe disease or at higher risk for asthma, systemic corticosteroids may be considered, although there remains insufficient evidence as to their efficacy. The patient in the introductory case lacks risk factors that would suggest systemic corticosteroids responsiveness (eg, positive API, previous asthma diagnosis, inhaled corticosteroid use, or severe disease) and would likely receive no clinical benefit from dexamethasone treatment."

For reference, click on the link

DOI 10.12788/jhm.3255