Comment in:

ACP J Club. 2002 Nov-Dec;137(3):107.

J Pediatr. 2002 Jan;140(1):8-9.

Efficacy of oral dexamethasone in outpatients with acute bronchiolitis.

Divisions of Emergency, Respiratory Medicine, and Paediatric Medicine, the Paediatric Outcomes Research Team and Research Institute, The Hospital for Sick Children, and the Department of Pediatrics, University of Toronto, Ontario, Canada.

OBJECTIVE: To examine the efficacy of oral dexamethasone in acute bronchiolitis. STUDY DESIGN: A double-blind randomized, placebo-controlled trial involving 70 children < 24 months old in the emergency department with Respiratory Disease Assessment Instrument > or = 6. Each patient received either 1 dose of 1 mg/kg of oral dexamethasone or placebo and was assessed hourly for a 4-hour period. Repeated measures regression analysis evaluated a change in the Respiratory Assessment Change Score (RACS). RESULTS: The 2 groups had similar baseline characteristics with Respiratory Disease Assessment Inventory of 9.4 +/- 2.3 in the dexamethasone group (n = 36) and 10.0 +/- 2.7 in the placebo group (n = 34). The RACS was -5.0 +/- 3.1 in the dexamethasone group and -3.2 +/- 3.7 in the placebo group (P =.029). Poor RACS occurred in 41% and 17% of the placebo and dexamethasone groups, respectively (P =.034). Of the children treated with dexamethasone, 19% were hospitalized compared with 44% in the placebo group (P =.039). There was no difference in RACS between the groups on day 7 (P =.75). CONCLUSION: Outpatients with moderate-to-severe acute bronchiolitis derive significant clinical and hospitalization benefit from oral dexamethasone treatment in the initial 4 hours of therapy.

PMID: 11815760 [PubMed - indexed for MEDLINE]