Corticosteroids do not affect the clinical or physiological status of infants with bronchiolitis

Abstract

The treatment of infants aged 1.5-11.0 months suffering from acute bronchiolitis with a combination of inhaled albuterol and systemic corticosteroids or inhaled albuterol and placebo was compared in 50 infants in a double blind study. The mean initial clinical score and the rate of improvement was similar in the two groups. The mean +/- SD hospital stay was 5.0 +/- 1.2 days for the steroid group and 5.2 +/- 1.7 days for the placebo group. Lung function was measured in 14 infants (7 from each group) and showed evidence of increased lung volumes and severe airway obstruction in the acute stage (the mean values for the steroid group were: TGV, 31 mL/kg; SGaw, 0.104 L/s.cmH2O; VmaxFRC, 12.9 mL/s/kg; for the placebo group: TGV, 35 mL/kg; SGaw, 0.104 L/s.cmH2O; VmaxFRC, 8.5 mL/s/kg) which had improved 2-4 weeks later (steroid group: TGV, 25 mL/kg; SGaw, 0.168 L/s.cmH2O; VmaxFRC, 21.6 mL/s/kg; -placebo group: TGV, 24 mL/kg, SGaw, 0.198 L/s.cmH2O, VmaxFRC, 17.5 mL/s/kg). There were no significant differences of thoracic gas volume, specific airway conductance, and forced expiratory flow at resting lung volume between the two groups, either in the acute or convalescent stages. We conclude that corticosteroids do not change the rate of clinical improvement in acute bronchiolitis, nor do they effect lung function 2-4 weeks later.

Dexamethasone for treatment of patients mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus

“…10 16-29 Although some found a beneficial effect, 10 16-19 21 22 most well designed randomised controlled trials did not show that corticosteroids were beneficial. [23][24][25][26][27][28][29] Like other workers, in an earlier trial we were unable to show that oral prednisolone was beneficial in patients with mild RSV-LRTI. 10 However, prednisolone shortened the duration of mechanical ventilation and the LOS in hospital in a small group of patients on mechanical ventilation.…”

Prednisolone Treatment of Respiratory Syncytial Virus Infection: A Randomized Controlled Trial of 147 Infants

“…8,12 Only in 1 study were tests of lung function performed. 9 Some of the studies had a 2-to 4-week follow-up, 7-9 but none had a long-term follow-up. Our study differs from the cited studies in the following aspects: 1) all infants with RSV infection ill enough to be hospitalized were eligible; 2) no infant was excluded because of mild or severe illness; 3) all included infants were asked to come for follow-up examinations 1 month and 1 year after admission to hospital; and 4) 10% of the included infants were applied nasal CPAP treatment, this nearly replaced mechanical ventilation.…”

Animal Pneumoviruses: Molecular Genetics and Pathogenesis

“…To this end, glucocorticoids are generally considered to have broad-reaching anti-inflammatory properties and in fact have been the focus of several clinical hRSV trials. Unfortunately, these trials suggest that when used alone in the absence of antivirals, glucocorticoid treatment has only marginal, if any, benefit in the treatment of hRSV-infection and its associated inflammatory response (72,83,84,212,213,231,307,331,334,338,365). A meta-analysis of several these studies demonstrated that systemic glucocorticoids reduced the total length of hospital stay by only 0.43 day per patient, an effect reduced to only 0.29 day per patient when patients with previous episodes of wheezing were excluded from the analysis (137), a statistically significant difference with overall minor clinical impact.…”