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.

Reference:
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)

Synopsis:
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.