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Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis: a randomized, controlled trial
T P Klassen1, T Sutcliffe, L K Watters
1Department of Pediatrics, University of Ottawa, Ontario, Canada.
Insights
Oral dexamethasone did not improve clinical outcomes for hospitalized children with bronchiolitis. This study found no significant benefit of dexamethasone over placebo in managing this common pediatric respiratory illness.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
- Respiratory Medicine
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Treatment often involves supportive care, with varying approaches to medication.
- The efficacy of corticosteroids like dexamethasone in bronchiolitis remains debated.
Purpose of the Study:
- To evaluate the clinical effectiveness of oral dexamethasone in hospitalized children with bronchiolitis.
- To compare outcomes between children receiving dexamethasone and those receiving a placebo.
- To assess the impact on respiratory distress and hospitalization duration.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted.
- Participants were infants (6 weeks to 15 months) hospitalized with first-time wheezing and low oxygen saturation or high Respiratory Distress Assessment Instrument (RDAI) scores.
- Children received either oral dexamethasone or placebo, alongside nebulized salbutamol.
Main Results:
- No significant difference in the mean change of RDAI scores at 24 hours between the dexamethasone and placebo groups (p = 0.74).
- No significant differences were observed in oxygen saturation, respiratory rate, or RDAI scores throughout the study.
- Hospital length of stay showed no statistically significant difference between the groups (p = 0.19).
Conclusions:
- Oral dexamethasone therapy does not alter the clinical course of hospitalized children with bronchiolitis.
- The use of dexamethasone is not recommended for treating hospitalized bronchiolitis in this patient population.
- Further research may be needed to explore specific subgroups or alternative treatments.
Objective:
To determine the clinical benefit of oral dexamethasone in children admitted to the hospital with bronchiolitis treated with nebulized salbutamol.
Methods:
Randomized, double-blind, placebo-controlled trial in the inpatient wards of a pediatric tertiary care hospital. The participants, children aged 6 weeks to 15 months, admitted with first-time wheezing, were eligible if their oxygen saturation was less than 95% on admission to the hospital and their Respiratory Distress Assessment Instrument (RDAI) score was greater than 6. Patients were excluded if they had any one of the following: an underlying disease that might affect cardiopulmonary status, asthma, recent treatment with steroids (within 2 weeks), or any history of adverse reaction to steroids. Patients were randomly assigned to receive either orally administered dexamethasone with 0.5 mg/kg as the first dose and 0.3 mg/kg for the next 2 mornings, or an equal volume of an orally administered placebo with an identical appearance. All patients received nebulized salbutamol at 0.15 mg/kg every 4 hours for the first 24 hours. The primary outcome measure was the change from baseline in the RDAI score at 24 hours. Secondary outcome measures were oxygen saturation, respiratory rate, RDAI measurement twice daily for the first 4 days, and the length of hospitalization.
Results:
At 24 hours the mean change (SD) from baseline in the RDAI score was 1.6 (2.3) in the placebo group (n = 28) and 1.4 (2.0) in the dexamethasone group (n = 33; p = 0.74). There were no significant differences between the two groups in change in oxygen saturation, respiratory rate, and RDAI score at any assessment period. The median length of stay (95% confidence interval) for the placebo group was 48 (42, 54) hours compared with 57 (38, 76) hours in the dexamethasone group (p = 0.19).
Conclusions:
Oral dexamethasone therapy does not affect the clinical course of children hospitalized with bronchiolitis and therefore cannot be recommended in this clinical situation.