Sep 16, 2013
Oral dexamethasone for 5 days reduced hospital stay for infants with bronchiolitis and eczema or a family history of asthma, according to results from a placebo-controlled trialpublished online September 16 in Pediatrics.
"Because steroid use is known to decrease admission rate and length of emergency stay in children with asthma but failed to do so in bronchiolitis, identifying asthmatic or preasthmatic patients and targeting them with steroid treatment early might improve symptoms and hasten recovery," write Khalid Alansari, MD, FRCPC, from the Division of Pediatric Emergency Medicine, Hamad Medical Corporation in Doha, Qatar, and colleagues. "A shorter stay and possibly a lower chance of needing return visits or subsequent hospitalization are desirable goals of better bronchiolitis therapy."
Therefore, the researchers designed a study to test the addition of dexamethasone to salbutamol in infants at risk for asthma, based on eczema or a family history of asthma in a first-degree relative. They enrolled 200 previously healthy infants, median age 3.5 months, with a diagnosis of bronchiolitis and asthma risk., All were treated with inhaled salbutamol and randomly assigned 1:1 to receive either dexamethasone, 1 mg/kg and then 0.6 mg/kg for 4 more days, or placebo.
Shorter Hospital Stay With Dexamethasone
Infants treated with salbutamol plus dexamethasone had a mean time to readiness for discharge of 18.6 hours (95% confidence interval [CI], 14.9 - 23.1 hours) compared with 27.1 hours (95% CI, 21.8 - 33.8 hours) for infants treated with salbutamol plus placebo. Dexamethasone was therefore associated with a 31% shortening of hospital stay (P = .015). In addition, during infirmary treatment, 5 infants in the placebo group, but none in the dexamethasone group, had to be admitted to intensive care (P = .02).
In the week after discharge, 22 infants in the dexamethasone group and 19 in the control group were readmitted to the short-stay infirmary (P = .9). During 7 days of monitoring, there were no reported hospitalizations or adverse effects.
"Dexamethasone with salbutamol shortened time to readiness for infirmary discharge during bronchiolitis episodes in patients with eczema or a family history of asthma in a first-degree relative," the study authors write. "Infirmary and clinic visits in the subsequent week occurred similarly for the 2 groups."
Limitations of this study include limited detail in safety reporting and lack of measurement of prevalences of patient eczema or atopy in the first-degree family of the bronchiolitis population.
"We speculate that a somewhat more prolonged dosing regimen may also reduce the need for post-discharge visits," the study authors conclude.
This study was sponsored by Hamad Medical Corporation. The authors have disclosed no relevant financial relationships.
Pediatrics. Published online September 16, 2013. Abstract