TORONTO — In infant outpatients with bronchiolitis who received corticosteroids in the emergency department, continuation of therapy beyond the initial dose appeared to offer no additional benefit, according to Dr. Suzanne Schuh of The Hospital for Sick Children in Toronto.
“Most babies with bronchiolitis do not need corticosteroids,” she said. “In fact, it's highly controversial, but one would wonder whether any of them need corticosteroids.”
“It's often difficult to tell whether a baby has acute asthma or bronchiolitis. Sometimes you can get a hint from the family history, but often babies with bronchiolitis will be given corticosteroids” before a definitive diagnosis is reached, Dr. Schuh explained at the annual meeting of the Pediatric Academic Societies.
“We asked in infants [who were] ultimately determined to have asthma if a single dose of corticosteroid is just as good as a 5- or 6-day course, and the answer was 'yes,'” she said.
In a randomized, double-blind study, Dr. Schuh and her colleagues looked at infants with bronchiolitis given 1 mg/kg oral dexamethasone in the ED and discharged on four further daily doses (0.15 mg/kg per day) versus those discharged on placebo.
Eligible infants were between 2 and 23 months of age, had bronchiolitis, and had baseline Respiratory Disease Assessment Instrument (RDAI) scores of 6 or greater. Average age was 8 months in the single-dose group (n = 61) and 7 months in the multiple-dose group (n = 64).
The primary outcome was the proportion of randomized outpatients subsequently hospitalized or given bronchodilators or corticosteroids for dyspnea outside of protocol by day 6.
The rate of primary outcome did not differ significantly between groups: 14% in the single-dose arm and 12% in the multiple-dose arm. In the single-dose arm, 19% of patients had unscheduled medical visits by day 6, compared with 18% in the multiple-dose arm, a nonsignificant difference. RDAI scores decreased in both groups from baseline, but did not differ between groups at day 4 or day 6.