Original ArticlesEfficacy of oral dexamethasone in outpatients with acute bronchiolitis☆,☆☆,★
Section snippets
Study patients
One trained study nurse was notified of all children with acute bronchiolitis who were seen between 8 AM and 9 PM in the emergency department of this hospital between November 1997 and April 2000. Children were enrolled if they were between 8 weeks and 23 months old, had the first wheezing episode associated with respiratory distress and an upper respiratory tract infection, and received a Respiratory Disease Assessment Instrument (RDAI) rating13 of ≥6 at baseline. Exclusion criteria included
Characteristics of the patients
During the three 6-month winter periods between November 1997 and April 2000, 1464 children arrived in our emergency department with a first-time episode of wheezing that was diagnosed as bronchiolitis. Of these 1464 children, 920 were not approached because the research nurse was not present. The children who arrived during the recruitment periods but had to be excluded from the study were (1) 91 younger than 8 weeks, (2) 140 with baseline RDAI <6, (3) 43 who were taking corticosteroids, (4)
Discussion
In our trial involving pediatric outpatients with acute bronchiolitis, the overall clinical improvement in the initial 4 hours among those given dexamethasone was greater than among those treated with placebo. The hospitalization rate in the dexamethasone group was less than one half that in the placebo group.
Although a recent meta-analysis suggests significantly greater improvement in the hospitalized infants with bronchiolitis treated with corticosteroids than infants treated with placebo,15
Acknowledgements
We thank the medical and nursing staff for their support and Jennifer Dobbin, Wendy Johnston, and Diana Cristea for typing this manuscript.
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Supported by grants from the Medical Research Council of Canada and Merck Frosst, Canada. The Paediatric Outcomes Research Team is supported by The Hospital for Sick Children Foundation. Dr. Dick receives financial support from the Ontario Ministry of Health and Long-Term Care through a Career Scientist Award (#05239).
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The results and conclusions are those of the authors; no official endorsement by the Ministry is intended or should be inferred.
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Reprint requests: Suzanne Schuh, MD, Division of Paediatric Emergency Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.