Dexamethasone Fails to Benefit in Bronchiolitis
Dexamethasone neither prevented hospital admission nor improved the respiratory status of babies aged 2–12 months who presented to the emergency department with moderate to severe bronchiolitis, reported Dr. Howard M. Corneli of the University of Utah, Salt Lake City, and his associates.
The corticosteroid also did nothing to reduce the patients' visits to the hospital or to physicians during the week following the emergency department visit, the researchers said.
Treatment for bronchiolitis is controversial. An estimated 25% of babies hospitalized with the disorder are given corticosteroids, even though the agents' efficacy has never been established definitively.
Dr. Corneli and his associates assessed outcomes in 600 babies treated for a first episode of moderate to severe bronchiolitis at 20 emergency departments throughout the United States during flu seasons in 2004–2006. The patients were randomly assigned to receive oral dexa-methasone or placebo, as well as any bronchodilators or other therapies that their treating physicians deemed necessary.
Four hours after treatment, the proportion of patients admitted to the hospital for observation and further treatment was 40% in the dexamethasone group and 41% in the placebo group, a difference that was not statistically significant.
Similarly, there was no significant difference between the two groups in mean scores on a measure of respiratory distress 4 hours after treatment. For patients who were admitted to the hospital, there was no significant difference in length of stay between those who received dexamethasone and those who received placebo.
The two study groups also showed no significant differences in the rates of hospitalization, physician visits, or adverse drug reactions in the week following their emergency department visits, the investigators said (N. Engl. J. Med. 2007;357:331–9).
These results held true regardless of whether or not the babies had eczema or a family history of asthma, which indicates that the response to corticosteroids was no different whether or not they had atopy.
Because respiratory syncytial virus can cause bronchiolitis, the researchers assessed outcomes according to whether or not patients tested positive for the virus. Again, they found no significant difference in response to dexamethasone between babies who had the virus and those who did not.
Given these findings, “we recommend evaluation of other treatments and preventive strategies for bronchiolitis,” Dr. Corneli and his associates said.
