Respiratory diseases account for about 25% of all pediatric consultations, and 10% of these are for asthma. The other main pediatric respiratory diseases, in terms of incidence, are bronchiolitis, acute bronchitis and respiratory infections. Oral corticosteroids, in particular prednisolone, are often used to treat acute respiratory diseases given their anti-inflammatory effects. However, the efficacy of treatment with oral corticosteroids differs among the various types of pediatric respiratory diseases. Notably, also the adverse effects of corticosteroid treatment can differ depending on dosage, duration of treatment and type of corticosteroid administered — a case in point being growth retardation in long-course treatment. A large body of data has accumulated on this topic. In this article, we have reviewed the data and guidelines related to the role of oral corticosteroids in the treatment and management of pediatric bronchiolitis, wheezing, asthma and croup in the attempt to provide guidance for physicians. Also included is a section on the management of acute respiratory failure in children.
SIDRIA. Asthma and respiratory symptoms in 6-7 years old Italian children: gender, latitude, urbanization and socioeconomic factors. SIDRIA (Italian studies on respiratory disorders in childhood and the environment). Eur Respir J. 1997;10:1780–6. CrossRef
Sestini P, De Sario M, Bugiani M, Bisanti L, Giannella G, Kaisermann D, et al. Frequency of asthma and allergies in Italian children and adolescents: results from SIDRIA-2. Epidemiol Prev. 2005;29:24–31. PubMed
Rubner FJ, Jackson DJ, Evans MD, Gangnon RE, Tisler CJ, Pappas TE, et al. Early life rhinovirus wheezing, allergic sensitization, and asthma risk at adolescence. 2016;(16)30276–7. Accessed 10 May.
von Mutius E. The microbial environment and its influence on asthma prevention in early life. J Allergy Clin Immunol. 2016;137:680–9. CrossRef
Longo D, Fauci D, Hauser S, Jameson J, Loscalzo J. Harrison’s principles of internal medicine. 18th ed. New York: Mc Graw Hill; 2011.
Brunton L, Chabner B, Knollman B. Goodman and Gilman’s the pharmacological basis of therapeutics. 12th ed. New York: Mc Graw Hill; 2011.
The Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2016.
Dawson KP, Sharpe C. A comparison of the acceptability of prednisolone tablets and prednisolone sodium phosphate solution in childhood acute asthma. Aust J Hosp Pharm. 1993;23:320–23.
National Collaborating Centre for Women’s and Children’s Health (UK). Bronchiolitis: diagnosis and management of bronchiolitis in children. London: National Institute for Health and Care Excellence (UK); 2015.
Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev. 2013;6:CD004878.
Tal A, Levy N, Bearman JE. Methylprednisolone therapy for acute asthma in infants and toddlers: a controlled clinical trial. Pediatrics. 1990;86:350–6. PubMed
Expert Panel Report 3 (EPR-3). Guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol. 2007;120:S94–S138. CrossRef
British Thoracic Society. Scottish intercollegiate guidelines network. British guideline on the management of asthma. Thorax. 2014;69 Suppl 1:1–192.
Indinnimeo L, Miraglia Del Giudice M, Chiappini E, Bernardini R, Capristo C, Cardinale F, et al. Gestione dell’attacco acuto di asma in eta’ pediatrica. In: Linea guida SIP - aggiornamento 2016. 2016. http://sip.it/wp-content/uploads/2016/09/LG-SIP-ASMA-ACUTO-Aggiornamento-2016.pdf. Accessed Oct 2016.
Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013;9:CD000052.
Griffiths B, Ducharme FM. Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Cochrane Database Syst Rev. 2013;8:CD000060.
van Asperen PP, Mellis CM, Sly PD, Robertson C. The role of corticosteroids in the management of childhood asthma: thoracic society of Australia and New Zealand. 2010.
Kliegman RM, Stanton BMD, Geme JS, Schor NF. Nelson textbook of pediatrics. Philadelphia, PA: Elsevier/Saunders; 2011.
Knutson D, Aring A. Viral croup. Am Fam Physician. 2004;69:535–40. PubMed
Toward Optimized Practice (TOP) Working Group for Croup. Guideline for the diagnosis and management of croup. Alberta, Canada: Edmonton (AB); 2003 (revised 2008).
Moore M, Little P. Humidified air inhalation for treating croup. Cochrane Database Syst Rev. 2006;19:CD002870.
Bjornson C, Russell K, Vandermeer B, Klassen TP, Johnson DW. Nebulized epinephrine for croup in children. Cochrane Database Syst Rev. 2013;10:CD006619.
Myers TR. AARC clinical practice guideline: selection of an oxygen delivery device for neonatal and pediatric patients--2002 revision & update. Respir Care. 2002;47:707–16. PubMed
O’Driscoll BR, Howard LS, Davison AG. BTS guideline for emergency oxygen use in adult patients. Thorax. 2008;63 Suppl 6:vi1–vi68. PubMed
Milesi C, Baleine J, Matecki S, Durand S, Combes C, Novais AR, et al. Is treatment with a high flow nasal cannula effective in acute viral bronchiolitis? A physiologic study. Intensive Care Med. 2013;39:1088–94.
Mayordomo-Colunga J, Medina A, Rey C, Concha A, Los Arcos M, Menendez S. Helmet-delivered continuous positive airway pressure with heliox in respiratory syncytial virus bronchiolitis. Acta Paediatr. 2010;99:308–11. PubMed
British Thoracic Society Standards of Care Committee. Non-invasive ventilation in acute respiratory failure. Thorax. 2002;57:192–211. CrossRef
Bell L. Middle respiratory tract infections. In: Jenson H, Baltimore R, editors. Pediatric infectious diseases: principle and practice. 2nd ed. Philadelphia: Saunders; 2002. p. 772.
Hammer J, Eber E. Paediatric pulmonary function testing. Basel: Karger; 2005. CrossRef
- Management of acute respiratory diseases in the pediatric population: the role of oral corticosteroids
Michele Miraglia Del Giudice
- BioMed Central
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