Some children with recurrent wheezing need antivirals – not steroids, study finds

Many children with recurrent wheezing issues would be better treated with antiviral medications instead of steroids, researchers at the University of Virginia found. 

In a study of 800 children with recurrent, severe wheezing issues, researchers found that 22% had lung infections that went undetected, because they did not display typical cold symptoms. That matters for doctors prescribing treatments, because these types of "silent" infections' don't respond to corticosteroids commonly used to treat wheezing. 

Higher doses of corticosteroids may increase these children's risk for lingering lung inflammation, and can cause side effects like irritability, reduced bone density and suppressed growth, the study found. Antiviral medications better treated recurrent wheezing without the side effects. 

"While steroids can help some children with wheeze, many children in the study showed no patterns of inflammation that would improve with steroids," said Dr. W. Gerald Teague, a pediatric pulmonologist at the the UVA School of Medicine's Child Health Research Center. "I advise the parents of my patients that wheeze episodes that are triggered by colds should be treated with anti-inflammatory medications that build immunity to viruses, such as azithromycin. They look surprised that we would use an antibiotic for a viral infection, but, in fact, azithromycin bolsters the immune response to viruses in a positive way."

Teague said he decided to study recurrent wheezing due to the large number of children who get referred to him through community health care providers and the UVA Health Emergency Department. Because rhinoviruses – the most common cause of a cold – can trigger wheezing, he wanted to see whether recurrent wheezing is linked to "silent' lung infections."

Rhinoviruses were the most common infection among the children in the study, but some unresolved respiratory infections were found, too. The researchers suspect an issue with mucosal immune cells in lungs might make it hard for children to combat these viruses.

Further research is need to better understand this immune malfunction, researchers said, but the issue primarily seemed to impact very young children; it was found less often among school-age children. 

"We hope this discovery will stimulate further work in the treatment of recurrent wheeze and viral infections in children," Teague said. "The field has to get to away from overuse of potentially toxic steroids for the treatment of acute wheeze to include novel therapies which target specific patterns of inflammation."