Weekly Article: Dexamethasone and bronchiolitis

By Alex Rucker 
Children's National 

Here's a seasonal article for you, semi-hot off the Pediatrics presses. Maybe steroids do have a role in bronchiolitis after all, at least for a lot of our patients... 

 

The objective was to compare a course of oral dexamethasone to placebo in bronchiolitis in 200 infants with eczema or a first degree relative with asthma. All study-eligible subjects were first time wheezers less than 18 months with a Wang bronchiolitis score less than or equal to 4 admitted to the Short Stay Unit.  

Interesting points

• The study took place in the only pediatric emergency center in Qatar (which includes their Short Stay Unit) over three consecutive bronchiolitis seasons. 
• Everyone got albuterol 2.5 mg nebs x 4, then q2h which is standard treatment for admitted patients with bronchiolitis on their unit. Racemic epi, oxygen, hydration, etc. were given at the provider's discretion. 
• The dex course was 1 mg/kg on D#1, then 0.6 mg/kg for 4 days thereafter. 
• The LOS for the dexamethasone group was 18.6 hours compared to 27.1 hours for the placebo group (p=0.015). Less patients in the dex group (19) vs. the placebo group (31) required racemic epi (p=0.03). Readmissions to the SSU, ED or other doctor's office within 7 days of discharge were similar in both groups. 

Wishing only happy wheezers to you and yours.