Elsevier

The Journal of Pediatrics

Volume 130, Issue 2, February 1997, Pages 191-196
The Journal of Pediatrics

Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis: A randomized, controlled trial,☆☆,,★★

https://doi.org/10.1016/S0022-3476(97)70342-1Get rights and content

Abstract

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. (J Pediatr 1997;130:191-6)

Section snippets

Study setting

The study was conducted at the Children's Hospital of Eastern Ontario, the only pediatric tertiary hospital for the Ottawa-Carleton region, with a catchment area of 1 million people. This hospital has 6800 admissions per year and 160 inpatient beds.

Selection of patients

Patients who had, for the first time, a short-term (fewer than 7 days) episode of wheezing and had evidence of a viral infection (rhinorrhea or temperature >37.5° C), and who were admitted to the inpatient wards, were eligible if they met the

Patient characteristics

The study was conducted from Feb. 1, 1993, to April 30, 1995; however, patients were enrolled only from Nov. 1 to April 30 during the peak RSV season. It was terminated after the enrollment of 72 patients because funding for the project had lapsed and we had enrolled 97% of our specified sample size. Of the 102 patients approached for the study, 30 patients did not participate because of parental refusal to give consent (n = 18), a communication barrier (n = 6), and an absent parent or guardian

DISCUSSION

This study demonstrates that oral dexamethasone is not effective as adjunctive therapy to nebulized salbutamol for children hospitalized with mild to moderate bronchiolitis. There was no significant difference between the RDAI scores of patients who received a placebo and those who received dexamethasone. The validity and responsiveness (sensitivity to change) of this clinical score has been demonstrated in other studies. 4, 14 The two groups did not differ significantly with respect to

Acknowledgements

We thank Joanne Momy, Sue Bedard, and Pat Harman for their excellent and dedicated work as research assistants, Colline Blanchard for randomization and preparation of study medication, John Lewis for his help with data entry, and the house staff, attending physicians, and nurses on the inpatient wards at the Children's Hospital of Eastern Ontario.

References (27)

  • DR Lines et al.

    Efficacy of nebulized salbutamol in bronchiolitis

    Pediatr Rev Commun

    (1990)
  • FA Oski et al.

    Steroid therapy in bronchiolitis: a double blind study

    Am J Dis Child

    (1961)
  • JH Connolly et al.

    A double blind trial of prednisolone in epidemic bronchiolitis due to respiratory syncytial virus

    Acta Pediatr Scand

    (1969)
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    From the Departments of Pediatrics, Epidemiology, and Medicine, University of Ottawa, Ottawa, Ontario, and the Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

    ☆☆

    Supported by grant 92-51 from Physicians Services Inc., Toronto, Ontario, Canada.

    Reprint requests: Terry P. Klassen, MD Division of Emergency Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa, Ontario K1H 8L1, Canada.

    ★★

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