A Controlled Clinical Trial of Steroids for Bronchiolitis

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Summary and Comment

A Controlled Clinical Trial of Steroids for Bronchiolitis

One dose of oral dexamethasone was no different than placebo.

Bronchiolitis is the leading cause of hospitalization among infants in the U.S. Use of steroids for infants with bronchiolitis remains controversial because of the lack of high-quality, sufficiently powered studies. In a multisite double-blind clinical trial, researchers randomized 600 infants (age range, 2–12 months) who presented to an emergency department with no prior history of wheezing and a clinical picture consistent with moderate-to-severe bronchiolitis to receive either a single dose of oral dexamethasone (1 mg/kg) or placebo. The primary outcome was hospitalization 4 hours after drug administration.

The admission rate was virtually identical in the steroid and placebo groups (39.7% and 41.0%, respectively). No differences emerged in subgroup analyses of infants who were positive for respiratory syncytial virus, those younger than 6 months, or those with a history of eczema or family history of asthma. Length of stay for hospitalized infants and subsequent admissions in the 7 days after the intervention were similar in the two groups.

Comment: This likely represents the definitive study of the use of steroids for infants with bronchiolitis in the ambulatory care setting. For infants with no history of wheeze, steroids convey no benefit. These results are consistent with a recent American Academy of Pediatrics guideline, which indicated that corticosteroids should not be used to treat bronchiolitis routinely.

— Howard Bauchner, MD

Published in Journal Watch General Medicine July 26, 2007