Jan. 21 (Bloomberg) -- Giving steroid pills to toddlers wheezing from colds doesn’t help them and isn’t worth the risk of stunting their growth or causing other side effects, said a study published today in the New England Journal of Medicine.

A second study in the same journal found that when parents gave GlaxoSmithKline’s Flovent, an inhaled steroid, to wheezing preschoolers, they were less likely to end up in the hospital after their symptoms worsened.

The results mean that clinical practice should change so that wheezing children aren’t routinely given prednisolone or other oral steroids unless they have allergic asthma, said Andrew Bush, academic director of pediatrics at the National Heart and Lung Institute in London, in an editorial accompanying the reports.

“There can no longer be any justification” for giving steroid pills to wheezing preschoolers who don’t have asthma unless doctors think the child’s condition is severe, Bush said in his editorial. “It is disturbing to contemplate how many unnecessary courses of prednisolone have been given over the years, in good faith, because we all assumed that preschool children are little adults.”

Wheezing among children is common. Almost one-third of children 4 years old or younger have intermittent wheezing and most of them will outgrow it, Bush said in his editorial. While some children who wheeze have allergic asthma, most wheeze as a result of getting an upper respiratory infection and stop wheezing when they get over their cold.

Evidence for Older Children

Evidence shows that older children and adults who have serious wheezing benefit from getting oral steroids, said Jonathan Grigg, professor of pediatric respiratory and environmental medicine at Queen Mary University in London, the lead author of the first study.

“There’s no argument about children older than 7,” Grigg said in a telephone interview today.

Younger children are a different story. Most doctors today treat young children with wheezing symptoms as they would older children and use steroids as “the bedrock of therapy,” Bush wrote in his editorial.

Grigg’s study suggests that practice is mistaken. He and his colleagues found that wheezing toddlers taken to hospitals in England weren’t discharged any sooner if they were given prednisolone than if they were given a placebo.

“We have shown no effect of steroids,” he said. “Routine use with preschool viral wheeze is not justified.”

Inhaled Steroid

The implications of the second study, which used high doses of Flovent, are less clear. Francine DuCharme, assistant director of clinical research at Sainte Justine Hospital in Montreal, and her colleagues followed 129 children with a history of developing asthma symptoms when they got colds. These children, who didn’t have classic allergic forms of asthma, had experienced repeated bouts of asthma with colds or been hospitalized at least once as a result of their symptoms.

Among the children who were given Flovent, 8 percent ended up being hospitalized and later being prescribed oral steroids to help them, compared with 18 percent of the children who inhaled a placebo treatment.

“It reduced by half the number of colds that progressed to moderate or severe flare-ups and by 20 percent the duration of the attack,” said DuCharme, the lead author, in a telephone interview today.

The children who used Flovent gained a little bit less height and weight than those who took placebos, she said. Their bone density wasn’t affected.

Doses Higher

While the doses used were well above those recommended for Flovent, which is approved for children ages 4 and older with asthma, the “results may help inform future research efforts into viral-induced wheezing,” said Mary Anne Rhyne, a Glaxo spokeswoman, in an e-mail today.

DuCharme said further research is needed to see if lower doses of Flovent would be useful and to calibrate the risk- benefit ratio of using the medicine in young children with asthma symptoms from colds. For now, she said, it should be used in young children as a last resort after other treatments have been tried and only after consulting a specialist.

To contact the reporter on this story: Rob Waters in San Francisco at rwaters5@bloomberg.net.

Last Updated: January 21, 2009 18:24 EST