Lit Matters #1: WASP - Wheeze and Steroids in Preschoolers

Preschool viral wheeze is a heterogeneous syndrome, and it does not behave like established asthma. In children with URI-associated wheezing, oral prednisolone may improve early symptoms and possibly reduce admission, but most are markedly better by 24 hours either way.

Preschool Wheeze and Steroids

• Heterogeneous preschool wheeze: Viral URI-associated wheeze in preschoolers is not synonymous with asthma; in this trial, about 90% had prior wheeze but only roughly one-third carried an asthma diagnosis.
• Primary outcome signal: The main endpoint was change in Preschool Respiratory Assessment Measure at 24 hours, and prednisolone did not improve that primary outcome over placebo.
• Early symptom improvement: Prednisolone showed its clearest benefit at 4 hours, with lower absolute PRAM scores and less need for escalation, a timing nuance we get into in the episode.
• Hospitalization trend: Admission rates trended lower with steroids, 23.5% versus 31.4%, suggesting a possible operational benefit even though statistical certainty was limited.
• Natural history at 24 hours: The key bedside reality is that most preschoolers with viral wheeze are much better by 24 hours with or without steroids, which should temper repeat dosing.
• Practical steroid takeaway: If steroids are used, the signal favors giving them early rather than layering on extra doses later; we walk through the restraint piece in the chapter.