A Controlled Clinical Trial of Steroids for Bronchiolitis

A Controlled Clinical Trial of Steroids for Bronchiolitis

One dose of oral dexamethasone was no different from placebo.

Bronchiolitis is the leading cause of hospitalization of 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 the 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 a family history of asthma. Mean length of stay for hospitalized infants and subsequent admissions during the 7 days after the intervention were similar in the two groups.

Comment: This study likely represents the definitive study on the use of steroids for infants with bronchiolitis in the ambulatory care setting — steroids convey no benefit. However, infants with a prior history of wheezing were excluded. I am sure some clinicians will continue to administer steroids to infants who are admitted with bronchiolitis despite the lack of compelling evidence. I do not believe that steroids have a role in the treatment of bronchiolitis.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine July 25, 2007