Original Articles
Efficacy of oral dexamethasone in outpatients with acute bronchiolitis,☆☆,

Presented at the Annual Meeting of the Society for Academic Emergency Medicine, May 5-8, 2001, Atlanta, Georgia.
https://doi.org/10.1067/mpd.2002.120271Get rights and content

Abstract

Objective: To examine the efficacy of oral dexamethasone in acute bronchiolitis. Study design: A double-blind randomized, placebo-controlled trial involving 70 children <24 months old in the emergency department with Respiratory Disease Assessment Instrument ≥6. Each patient received either 1 dose of 1 mg/kg of oral dexamethasone or placebo and was assessed hourly for a 4-hour period. Repeated measures regression analysis evaluated a change in the Respiratory Assessment Change Score (RACS). Results: The 2 groups had similar baseline characteristics with Respiratory Disease Assessment Inventory of 9.4 ± 2.3 in the dexamethasone group (n = 36) and 10.0 ± 2.7 in the placebo group (n = 34). The RACS was –5.0 ± 3.1 in the dexamethasone group and –3.2 ± 3.7 in the placebo group (P = .029). Poor RACS occurred in 41% and 17% of the placebo and dexamethasone groups, respectively (P = .034). Of the children treated with dexamethasone, 19% were hospitalized compared with 44% in the placebo group (P = .039). There was no difference in RACS between the groups on day 7 (P = .75). Conclusion: Outpatients with moderate-to-severe acute bronchiolitis derive significant clinical and hospitalization benefit from oral dexamethasone treatment in the initial 4 hours of therapy. (J Pediatr 2002;140:27–32.)

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).

    ☆☆

    The results and conclusions are those of the authors; no official endorsement by the Ministry is intended or should be inferred.

    Reprint requests: Suzanne Schuh, MD, Division of Paediatric Emergency Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.

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