DEXAMETHASONE IN SALBUTAMOL-TREATED INPATIENTS WITH ACUTE BRONCHIOLITIS - A RANDOMIZED, CONTROLLED TRIAL

Objective: To determine the clinical benefit of oral dexamethasone in children admitted to the hospital with bronchiolitis treated with nebu lized salbutamol. Methods: Randomized, double-blind, placebo-controlle d trial in the inpatient wards of a pediatric tertiary care hospital. The participants, children aged 6 weeks to 15 months, admitted with fi rst-time wheezing, were eligible if their oxygen saturation was less t han 95% on admission to the hospital and their Respiratory Distress As sessment Instrument (RDAI) score was greater than 6. Patients were exc luded if they had any one of the following: an underlying disease that might affect cardiopulmonary status, asthma, recent treatment with st eroids (within 2 weeks), or any history of adverse reaction to steroid s. Patients were randomly assigned to receive either orally administer ed dexamethasone with 0.5 mg/kg as the first dose and 0.3 mg/kg for th e next 2 mornings, or an equal volume of an orally administered placeb o with an identical appearance. All patients received nebulized salbut amol at 0.15 mg/kg every 4 hours for the first 24 hours. The primary o utcome measure was the change from baseline in the RDAI score at 24 ho urs. Secondary outcome measures were oxygen saturation, respiratory ra te, RDAI measurement twice daily for the first 4 days, and the length of hospitalization. Results: At 24 hours the mean change (SD) from bas eline in the RDAI score was 1.6 (2.3) in the placebo group (n = 28) an d 1.4 (2.0) in the dexamethasone group (n = 33; p = 0.74). There were no significant differences between the two groups in change in oxygen saturation, respiratory rate, and RDAI score at any assessment period. The median length of stay (95% confidence interval) for the placebo g roup was 48 (42, 54) hours compared with 57 (38, 76) hours in the dexa methasone group (p = 0.19). Conclusions: Oral dexamethasone therapy do es not affect the clinical course of children hospitalized with bronch iolitis and therefore cannot be recommended in this clinical situation .