Quanto funziona il cortisone per os nel broncospasmo acuto in età prescolare? Risultati non confortanti di un RCT

Abstract

How does oral cortisone work in acute bronchospasm in preschool age? ARCT with not reassuring results. The 2021 guide of the Global Initiatve for Asthma (GINA) states that the use of oral steroids in preschool children with acute bronchospasm is only recommended in cases of severe exacerbation, however the literature continues to present conflicting results. The Wheeze and Steroids in Preschoolers (WASP) Study, conducted in 3 New Zealand emergency rooms, randomized 477 children aged 24–59 months with acute bronchospasm to receive oral prednisolone for 3 days versus placebo. The respiratory outcomes measured were conflicting: the change in severity score (PRAM) at 24 hours was not different between the 2 groups, while the absolute value of the score at both 4 and 24 hours (secondary outcomes) was significantly lower in the prednisolone group. Hospitalization rate, need for further oral prednisolone treatment, and intravenous drug use were also lower in the prednisolone group. It is debated whether the equivalence design of the study and the margins chosen by the authors for the primary outcome have attenuated the difference between the treatments.