Introduction. Our systematic review (SR) of the effects of oral corticosteroids (OCS) on preschool wheeze found inconclusive effects due to high heterogeneity between RCTs. We conducted an Individual Participant Data (IPD) meta-analysis from RCTs to evaluate the efficacy of OCS for preschool wheeze treatment. 

Methods. IPD were obtained from seven trials identified from our SR (n=2172). We analysed the following outcomes in children aged 12-71 months (n= 1823): change in wheezing severity score (WSS); length of hospital stay (LOS); and revisit to GP/emergency department (ED) or hospital.  Two-stage meta-analysis using a random-effects model was used.

Results. Compared to the placebo group, the change in WSS at 4 hours in the OCS group showed a mean difference (MD) of -0.31 (95% CI= -0.38 to -0.24, I²= 0.0%) in the two studies where data were available after adjusting for age (months), allergies and parental allergies. For change in WSS at 12 hours, the MD in three studies was 0.09 (95% CI: -0.69 to 0.87, I²= 0.0%). In five studies, OCS treatment was associated with an MD in LOS of -3.18 hours (95% CI= -4.43 to -1.93, I²= 0.0%). For revisit to GP/ED and rehospitalisation, the pooled ORs in seven studies were respectively 1.11 (95% CI= 0. 86 to 1.43, I²= 0.0%) and 0.94 (95% CI= 0.38 to 2.32, I²= 20.3%). There was no evidence of a subgroup in whom OCS had a preferential benefit.

Conclusions.  OCS could be beneficial for short-term outcomes for acute wheeze in preschool children, but does not appear to have benefits for repeat healthcare utilisation.