Corneli HM, Zorc JJ, Majahan P, et al. N Engl J Med. 2007;357(4):331–339
PURPOSE OF THE STUDY. To evaluate the efficacy of a single dose of oral dexamethasone (1 mg/kg) compared with placebo in the treatment of acute bronchiolitis.
STUDY POPULATION. A total of 600 children (aged 2–12 months) with a first episode of wheezing diagnosed in the emergency department as moderate-to-severe bronchiolitis were included.
METHODS. Patients were enrolled at 20 emergency departments during the months of November through April over a 3-year period. The primary outcome was respiratory assessment and score change during the first 4 hours. Later outcomes evaluated included length of hospital stay, medical visits, and adverse events.
RESULTS. Baseline characteristics were similar for both groups. The admission rate was 39.7% for children assigned to dexamethasone compared with 41% for those assigned to placebo. Both groups had improvement during the observation period with similar mean changes in respiratory assessment score. For the patients admitted to the hospital, there was no difference in mean hospital stay (2.55 vs 2.27 days), subsequent hospital admissions, or adverse events.
CONCLUSIONS. Single-dose dexamethasone did not prevent hospital admission for bronchiolitis.
REVIEWER COMMENTS. This study finally allows for a definitive statement that no significant benefit can be seen with the use of corticosteroid for first episodes of wheezing. It should be noted that bronchodilator treatment was not regulated but seemed not to affect outcomes because treatment was equally distributed between the groups. This continues to strengthen the notion that supportive therapy with good hydration and preventing hypoxia are the most important interventions for a first episode of bronchiolitis.
- Copyright © 2008 by the American Academy of Pediatrics