Management of acute respiratory diseases in the pediatric population: the role of oral corticosteroids

Abstract

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.

Precision Medicine in Childhood Asthma: Omic Studies of Treatment Response

“…Children with severe asthma require add-on therapies such as oral corticosteroids (OCSs), which are similar to ICSs, except for the systemic effects derived from oral administration. As a consequence, the incidence of adverse reactions increases with OCS treatment, which limits its application to the most severe cases [5,9].…”

Patterns of health care use related to respiratory conditions in early life: A birth cohort study with linked administrative data

“…Currently available methods for respiratory disease detection commonly rely on subjective measures such as parental report of symptoms, which may be incomplete, imprecise, and subject to recall bias . Furthermore, childhood respiratory illness itself is heterogeneous, varied by the manifestation and interaction of respiratory tract infections and allergic diseases involving the upper (allergic rhinitis) and lower (asthma) airway across children and within the same child over time . From a health economic perspective, a better understanding of differential needs for respiratory‐related health care among children, and underlying reasons for those needs may inform population‐level monitoring and precision or personalized medicine.…”

“…9 Furthermore, childhood respiratory illness itself is heterogeneous, varied by the manifestation and interaction of respiratory tract infections and allergic diseases involving the upper (allergic rhinitis) and lower (asthma) airway across children and within the same child over time. 10,11 From a health economic perspective, a better understanding of differential needs for respiratory-related health care among children, and underlying reasons for those needs may inform population-level monitoring and precision or personalized medicine. As the early-life disease has a robust and economically meaningful impact on lifetime well-being, 12 identifying children with a high demand for respiratory care early in life may facilitate prevention and intervention strategies to minimize their long-term morbidity.…”

Detection of Common Respiratory Viruses in Patients with Acute Respiratory Infections Using Multiplex Real-Time RT-PCR

“…Concerning clinical manifestations of ARI, it is difficult to distinguish between RSV, HMPV, influenza virus (A, B), HPIVs (1)(2)(3)(4) and HCoVs (OC43/HKU1, NL63, 229E) infections. Therefore, the primary diagnosis is important to ease the early management and control of ARIs (15).…”