Oral steroids for preschool children with acute wheeze: a systematic review and meta-analysis

Background: Benefits of oral corticosteroids (OCS) for acute preschool wheeze are unclear. Aim: Systematically review evidence for OCS in preschool children presenting to the emergency department (ED) or hospitalised with acute wheeze. Methods: We included randomised controlled trials of OCS vs placebo for children Results: Four studies were eligible. Risk of bias was generally low except for selective outcome reporting. OCS did not reduce risk of hospitalisation (Risk ratio 0.94,95%CI 0.80,1.12; Figure 1). Of 3 studies reporting LOS, 2 showed statistically but not clinically significant reduction (placebo 9 hours [IQR 2-16] vs OCS 6.2 [2–11.8] p0.04; and placebo 7.7 hours[5.0-22.9] versus OCS 6.8[4–14] p0.03). Atopic history, and interval symptoms were not consistently associated with better response to OCS. Severity and prior diagnosis of asthma were associated with response in one study. Conclusion: High quality evidence suggests OCS should not be used in the ED in acute preschool wheeze. Effects on those with known asthma or hospitalised with severe illness are uncertain.