EFFICACY OF CORTICOSTEROIDS IN ACUTE BRONCHIOLITIS - SHORT-TERM AND LONG-TERM FOLLOW-UP

Corticosteroids continue to be used by many physicians to treat infant s with bronchiolitis. The aim of this study was to examine the short-t erm and long-term efficacy of oral corticosteroid therapy when added t o beta 2-agonists in infants with mild to moderate bronchiolitis (defi ned as the first episode of wheezing associated with low grade fever, rhinitis, tachypnea, and increased respiratory effort in a previously healthy infant during the winter months). infants with mild to moderat e bronchiolitis, were randomly assigned to receive either oral prednis one (2 mg/kg/day) or placebo for 3 days. All patients received nebuliz ed albuterol q.i.d. during this period. Upon admission and after 3 day s of therapy, a clinical score was assigned based on respiratory rate, use of accessory muscle, and the presence of wheeze. Oxygen saturatio n (SaO(2)) was also measured. On day 7, we inquired as to the well-bei ng of each child. Two years later, the development of chronic respirat ory symptoms was assessed. Thirty-eight infants were enrolled in the s tudy; 20 received prednisone and 18 received placebo. Both groups were similar in terms or: age, duration of illness prior to enrollment, pr etrial medication use, clinical severity of bronchiolitis, history of atopy, and family history of atopy. After 3 and 7 days of treatment, b oth groups showed similar clinical improvement and there were no stati stically significant differences between the two groups in the clinica l score or in the SaO(2). No major side effects were observed. Two yea rs later, 32% of the infants continued to suffer from chronic respirat ory symptoms, with a similar prevalence in both groups. We conclude th at a 3-day course of oral corticosteroids is of no benefit to infants with mild to moderate bronchiolitis who are also treated with an inhal ed beta 2-agonist. (C) 1998 Wiley-Liss, Inc.