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Steroids Have No Benefit for Bronchiolitis

A multicenter trial shows no benefit over placebo.

Bronchiolitis is the most common reason for hospitalization of infants in the U.S., and the possible role for steroid treatment has been hotly debated. To assess the efficacy of dexamethasone, researchers conducted a randomized, double-blind, placebo-controlled trial in infants aged 2 to 12 months at 20 emergency departments during three respiratory virus seasons. Inclusion criteria included first episode of wheezing and an ED diagnosis of moderate-to-severe bronchiolitis (defined as a Respiratory Distress Assessment Instrument [RDAI] score 6).

Of 8686 infants screened, 93% were excluded because of prior wheezing (41% of excluded cases), an RDAI score <6 (25%), or other reasons. Overall, 600 infants were randomized to receive either a single dose of dexamethasone (1 mg/kg up to a maximum of 12 mg) or placebo. All other care was at the discretion of the attending physician. Most patients received bronchodilators.

There were no differences between the dexamethasone and placebo groups in admission rates (the primary outcome), respiratory status 4 hours after treatment, hospital length of stay, or readmission rates. The findings remained the same in infants who were positive or negative for respiratory syncytial virus and in those with and without eczema or a family history of asthma.

Comment: This properly sized, well-designed study should end the use of steroids in children with bronchiolitis. If steroids did have an effect, the inclusion of only patients with moderate-to-severe disease should have favored them by eliminating the mild cases from which recovery is virtually ensured, regardless of treatment. Similarly, the exclusion of patients with prior episodes of wheezing, which might represent asthma, makes this a clean decision: First episode of wheezing means no steroids, period.

— J. Stephen Bohan, MD, MS, FACP, FACEP

Published in Journal Watch Emergency Medicine July 25, 2007

Citation(s):

Corneli HM et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med 2007 Jul 26; 357:331-9.

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