University of Oulu

Hurme, P, Homil, K, Lehtinen, P, et al. Efficacy of inhaled salbutamol with and without prednisolone for first acute rhinovirus-induced wheezing episode. Clin Exp Allergy. 2021; 51: 1121– 1132.

Efficacy of inhaled salbutamol with and without prednisolone for first acute rhinovirus-induced wheezing episode

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Author: Hurme, Pekka1; Homil, Kiara1; Lehtinen, Pasi1,2;
Organizations: 1Department of Paediatrics and Adolescent Medicine, University of Turku, Turku, Finland
2Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
3Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
4Department of Biostatistics, University of Turku, Turku, Finland
5Institute of Biomedicine, University of Turku, Turku, Finland
6Department of Clinical Microbiology, Turku University Hospital, Turku, Finland
7Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
8Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
9Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
10Department of Pediatrics, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2021-10-11


Background: Acute rhinovirus-induced wheezing is common in young children and may respond to systemic corticosteroid. There are no trials on the efficacy of inhaled beta₂-agonist in this clinical scenario.

Objective: To study post hoc the short-term (up to 2 months) efficacy of inhaled beta2-agonist with and without oral corticosteroid in the first acute rhinovirus-induced severe wheezing episode in young hospitalized children.

Methods: The study population came from two randomized controlled trials comparing oral prednisolone (2 mg/kg/d for 3 days) to placebo: Vinku (n = 35, NCT00494624) used high-dose regular nebulized salbutamol (0.15 mg/kg 2–4 h intervals) and Vinku2 (n = 60, NCT00731575, EudraCT 2006-007100-42) used inhaled salbutamol on-demand. Both studies used identical detailed follow-up assessments. The primary outcome of the former was the duration of hospitalization and of the latter the occurrence of and the time to a new physician-confirmed wheezing episode within 2 months after discharge. Treatment groups included salbutamol high-dose vs. salbutamol on-demand while adjusting for prednisolone status and acknowledging for interactions with exception of the duration of hospitalization in which prednisolone groups could not be fully used due to protocol differences.

Results: Median age of subjects was 13 months, 32% were sensitized and 22% had doctor-diagnosed eczema. In the duration of hospitalization, salbutamol high-dose/placebo versus salbutamol on-demand/placebo groups did not differ (p = .12). In the occurrence of and time to relapse within 2 months, a significant group × treatment interaction was observed (both p = .02), such that high-dose group had less and longer time to relapses than on-demand group in prednisolone arm (both p < .05), but no difference was detected in placebo arm (both p > .26).

Conclusions: In young, hospitalized children with first episode of rhinovirus-induced wheezing, high-dose inhaled salbutamol may interact with oral prednisolone. However, further trials are warranted.

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Series: Clinical & experimental allergy
ISSN: 0954-7894
ISSN-E: 1365-2222
ISSN-L: 0954-7894
Volume: 51
Issue: 9
Pages: 1121 - 1132
DOI: 10.1111/cea.13960
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3123 Gynaecology and paediatrics
Funding: Supported by the Academy of Finland (grant numbers 132595 and 114034), Helsinki; the Finnish Medical Foundation, Helsinki; the Sigrid Juselius Foundation, Helsinki; the Foundation for Pediatric Research, Helsinki; the Finnish Cultural Foundation, Turku and Helsinki; the Turku University Foundation, Turku; the Paulo Foundation, Helsinki; and the Allergy Research Foundation, Helsinki -- all in Finland
Copyright information: © 2021 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.