There is uncertainty about the value of inhaled bronchodilators and steroids for infants who wheeze. Now a multicentre trial in Canada has shown that treatment with oral dexamethasone and inhaled epinephrine (adrenaline) in the emergency department reduced rates of hospital admission.
The trial was carried out at eight centres during December to April in 2004–2007. A total of 800 infants aged 6 weeks–12 months (median age, 5 months) with a diagnosis of acute bronchiolitis (defined as a first episode of wheezing associated with signs of an upper respiratory tract infection during the peak respiratory syncytial virus season) were randomized to four treatment groups in the emergency department: epinephrine plus dexamethasone (ED), epinephrine plus placebo (EP), dexamethasone plus placebo (DP), and double placebo (PP). Epinephrine was given as two doses each of 3 mL of 1:1,000 solution via a nebulizer. Dexamethasone was given orally in an initial dose of 1 mg/kg followed by five doses of 0.6 mg/kg at 24hour intervals. Rates of hospital admission by day 7 were 17% (ED), 24% (EP), 26% (DP) and 26% (PP). There was a significant 35% risk reduction in the ED group, but this result became insignificant after statistical adjustment.
Giving oral dexamethasone and inhaled epinephrine to infants with viral wheeze (paediatricians in Britain might give a diagnosis of wheezy bronchitis) may reduce the need for hospital admission.
Plint AC, et al. Epinephrine and dexamethasone in children with bronchiolitis. NEJM 2009;360:2079–2089; Frey U, von Mutius E. The challenge of managing wheezing in infants. Ibid: 2130–2133 (editorial).