Oral Dexamethasone for Bronchiolitis: A Randomized Trial

Abstract

OBJECTIVE: Determine whether dexamethasone treatment added to salbutamol reduces time to readiness for discharge in patients with bronchiolitis and possible asthma. METHODS: We compared efficacy and safety of dexamethasone, 1 mg/kg, then 0.6 mg/kg for 4 more days, with placebo for acute bronchiolitis in patients with asthma risk, as determined by eczema or a family history of asthma in a first-degree relative. All patients received inhaled salbutamol. Time to readiness for discharge was the primary efficacy outcome. RESULTS: Two hundred previously healthy infants diagnosed with bronchiolitis, median age 3.5 months, were enrolled. Five placebo recipients needed admission to intensive care unit during infirmary treatment (P = .02). Among 100 dexamethasone recipients, geometric mean time to readiness for discharge was 18.6 hours (95% confidence interval [CI], 14.9 to 23.1 hours); among 90 control patients, 27.1 hours (95% CI, 21.8 to 33.8 hours). The ratio, 0.69 (95% CI, 0.51 to 0.93), revealed a mean 31% shortening of duration to readiness for discharge favoring dexamethasone (P = .015). Twenty-two dexamethasone and 19 control patients were readmitted to the short stay infirmary in the week after discharge (P = .9). No hospitalizations or side effects were reported during 7 days of surveillance. CONCLUSIONS: Dexamethasone with salbutamol shortened time to readiness for infirmary discharge during bronchiolitis episodes in patients with eczema or a family history of asthma in a first-degree relative. Infirmary and clinic visits in the subsequent week occurred similarly for the 2 groups.

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

“…88 Basic science studies focused on understanding the interaction between β agonists and corticosteroids have shown potential mechanisms for why simultaneous administration of these drugs could be synergistic. [89][90][91][92] However, other bronchiolitis trials of corticosteroids administered by using fixed simultaneous bronchodilator regimens have not consistently shown benefit [93][94][95][96][97] ; hence, a recommendation regarding the benefit of combined dexamethasone and epinephrine therapy is premature.…”

Update on the utility of corticosteroids in acute pediatric respiratory disorders

“…Finally, oral dexamethasone (1 mg/kg on day 1, followed by 0.6 mg/kg for four additional days) given to hospitalized bronchiolitis patients who have eczema or a first degree family member with asthma shortened the duration of the hospitalization. 49 The results of these studies must be confirmed in additional trials before any change to the recommendation to not administer corticosteroids for viral bronchiolitis is considered.…”

Practice Variations between Emergency Physicians and Pediatricians in Treating Acute Bronchiolitis in the Emergency Department: A Nationwide Study

“…In addition, the routine use of many common medications, including bronchodilators; corticosteroids; ribavirin; and antibiotics, and chest x-ray study have not been shown to be effective in improving the clinical course of the illness (4,5). Although some of the recommendations are controversial because a recent randomized controlled trial study and Cochrane systematic reviews showed that oral dexamethasone can reduce time to discharge from observation unit and nebulized epinephrine can reduce hospital admission rate, routine use of diagnostic tests, such as chest x-ray study, white blood count, and viral test are still not recommended (6,7). However, recent research has shown that emergency departments (EDs) continue to use nonrecommended practices in patients presenting with acute bronchiolitis (8).…”