High oral corticosteroid use during acute attacks of preschool wheeze irrespective of clinical phenotype

Objective This study aims to evaluate the burden of oral corticosteroid (OCS) use and any relationship to clinical phenotype in preschool children presenting with acute wheeze attacks. Methods Single-centre prospective study in which children with recurrent, severe preschool wheeze (PSW), who were referred to a tertiary respiratory centre, had symptom questionnaire, point-of-care blood eosinophil count (BEC) and aeroallergen sensitisation tests undertaken on the same day as their outpatient clinic appointment. Results 100 children with PSW (median age 3.5 years; IQR 2.8–4.9 years; 51% male) were recruited. Clinical atopy, based on parental reporting, was present in 42%, while objective sensitisation, confirmed by testing, was observed in 35%. Median lifetime OCS courses per child was 10 (IQR 6–18) and 5 (IQR 3–7) during the preceding 12 months. Regardless of which definition of atopy was used, atopic children had higher BEC when well, compared with non-atopic children: using clinical atopy classification, median BEC was 0.65 versus 0.3×10⁹/L (p=0.003) and using objective atopy, median BEC was 0.7 versus 0.3×10⁹/L (p<0.0001). There was no difference in the use of OCS in the acute setting between higher and lower BEC, between clinical or objective atopy or a combination of these either over the child’s lifetime or during the previous 12 months. Conclusion Children with severe, recurrent PSW are being treated with large numbers of OCS courses despite the lack of evidence of significant efficacy. There is an urgent need for trials which include phenotyping of acute attacks to guide OCS treatment.