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Steroids do not improve RSV-related wheeze in children
  1. R P H Tofts
  1. Correspondence to Dr R P H Tofts, Intern, Internal Medicine, Cleveland Clinic, Weston, Florida, USA; rtofts{at}

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Respiratory syncytial virus (RSV)-related lower respiratory tract infection is common in infants and is often followed by recurrent wheeze and morbidity. This double-blind placebo controlled trial investigated whether early glucocorticoids prevent recurrent wheeze.

The 243 participants were infants (aged <13 months) admitted to hospital with RSV (confirmed by immunofluorescence) from 19 clinical centres. They were randomised to receive beclometasone or placebo for 3 months and were followed up for 1 year. The primary outcome measure was number of days with wheeze.

No significant difference was found in the number of days or proportion of infants with wheeze. However, a temporary small relative reduction (32%) in wheeze was noted in the steroid group compared with the placebo group in the first 6 months in those infants who did not require mechanical ventilation (n = 221). Secondary outcome measures did not show evidence of side effects or a positive effect on health-related quality of life. The authors conclude that steroids have no major effect on recurrent wheeze post-RSV infection, and general early use is not advocated. They suggest that future studies investigate ventilated infants separately. Interestingly, this research supports other work which shows that inhaled steroids provide a partially effective strategy in children with postviral episodic wheezing; further research is warranted.

▸ Ermers MJJ, Rovers MM, van Woensel JB, et al on behalf of the RSV Corticosteroid Study Group. The effect of high dose inhaled corticosteroids on wheeze in infants after respiratory syncytial virus infection: randomised double blind placebo controlled trial. BMJ 2009;338:b897.

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