Effect of inhaled corticosteroids on episodes of wheezing associated with viral infection in school age children: randomised double blind placebo controlled trial

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Abstract
Objectives: To determine the effect of regular prophylactic inhaled corticosteroids on wheezing episodes associated with viral infection in school age children. Design: Randomised, double blind, placebo controlled trial. Setting: Community based study in Southampton. Subjects: 104 children aged 7 to 9 years who had had wheezing in association with symptoms of upper and lower respiratory tract infection in the preceding 12 months. Interventions: After a run in period of 2–6 weeks children were randomly allocated twice daily inhaled beclomethasone dipropionate 200 μg or placebo through a Diskhaler for 6 months with a wash out period of 2 months. Children were assessed monthly. Main outcome measures: Forced expiratory volume in 1 second (FEV1); bronchial responsiveness to methacholine (PD20); percentage of days with symptoms of upper and lower respiratory tract infection with frequency, severity, and duration of episodes of upper and lower respiratory symptoms and of reduced peak expiratory flow rate. Results: During the treatment period there was a significant increase in mean FEV1 (1.63 v 1.53 l; adjusted difference 0.09 l (95% confidence interval 0.04 to 0.14); P=0.001) and methacholine PD20 (12.8 v 7.2 μmol/l; adjusted ratio of means 1.7 (1.2 to 2.4); P=0.007) in children receiving beclomethasone dipropionate compared with placebo. There were, however, no significant differences in the percentage of days with symptoms or in the frequency, severity, or duration of episodes of upper or lower respiratory symptoms or of reduced peak expiratory flow rate during the treatment period between the two groups. Conclusions: Although lung function is improved with regular beclomethasone dipropionate 400 μg/day, this treatment offers no clinically significant benefit in school age children with wheezing episodes associated with viral infection. Increasing evidence suggests that episodic wheezing in children in association with viral infections is a separate entity from atopic asthma Although inhaled corticosteroids are beneficial in asthma, their role in treating wheezing associated with viral infections is unclear In this study regular inhaled corticosteroids resulted in improved lung function and decreased bronchial responsiveness but did not have any effect on episodes of wheezing Inhaled corticosteroids are of little benefit in children with episodic wheezing associated with viral infection