Clinical Health Updates

Dexamethasone not effective for bronchiolitis

Clinical Question:
Is dexamethasone effective for the treatment of bronchiolitis?

Bottom Line:
Oral dexamethasone is not an effective treatment for moderate to severe bronchiolitis.

Corneli HM, Zorc JJ, Majahan P, et al, for the Bronchiolitis Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). A multicenter randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med 2007; 357:331-339.

Study Design:
Randomized controlled trial (double-blinded)

Bronchiolitis, the most common infection of the lower respiratory tract in infants, is a leading cause of hospitalization in childhood. Corticosteroids are commonly used to treat bronchiolitis, but evidence of their effectiveness is limit. The authors conducted a double-blind, randomized trial comparing a single dose of oral dexamethasone (1 mg per kilogram of body weight) with placebo in 600 children (age range, 2 to 12 months) with a first episode of wheezing diagnosed in the emergency department as moderate-to-severe bronchiolitis (defined by a Respiratory Distress Assessment Instrument score > or =6). They enrolled patients at 20 emergency departments during the months of November through April over a 3-year period. The primary outcome was hospital admission after 4 hours of emergency department observation. The secondary outcome was the Respiratory Assessment Change Score (RACS). They also evaluated later outcomes: length of hospital stay, later medical visits or admissions, and adverse events. Baseline characteristics were similar in the two groups. The admission rate was 39.7% for children assigned to dexamethasone, as compared with 41.0% for those assigned to placebo (absolute difference, -1.3%; 95% confidence interval [CI], -9.2 to 6.5). Both groups had respiratory improvement during observation; the mean 4-hour RACS was -5.3 for dexamethasone, as compared with -4.8 for placebo (absolute difference, -0.5; 95% CI, -1.3 to 0.3). Multivariate adjustment did not significantly alter the results, nor were differences detected in later outcomes.