Researchers Find Steroids Ineffective for Bronchiolitis
10/31/2007The use of steroid medication to treat bronchiolitis — a common viral lower respiratory infection in infants — does not prevent hospitalization or improve their respiratory symptoms, according to a recent multicenter clinical trial published in the New England Journal of Medicine.
The findings by the Pediatric Emergency Care Applied Research Network (PECARN) resolve controversy from prior research and are expected to help guide treatment for the most common cause of infant hospitalization.
The PECARN network includes 21 affiliated hospitals and their emergency departments and conducts multi-institutional research in the prevention and management of acute illnesses and injuries in children.
Children's Hospital investigators served as co-leaders of the PECARN study, which compared hospitalization rates for 600 children between the ages of 2 months and 12 months who visited emergency rooms with bronchiolitis between November and April during a three-year period. Bronchiolitis is most common during the winter months.
Patients taking part in the study were treated with either a dose of dexamethasone (a glucocorticoid form of steroid medication) or a placebo, and evaluated after one hour and again at four hours. The hospital admission rate for both groups was identical at nearly 40 percent. Both groups improved during treatment, but the investigators found the placebo group did as well as those treated with active medication.
"This study provides solid evidence to guide treatment of this common illness," said Joseph Zorc, M.D., an emergency physician at Children's Hospital and a lead co-investigator on the PECARN study. "Current recommendations suggest that simple supportive care is the best available treatment for bronchiolitis. This study will help resolve some of the uncertainty for physicians and families and prevent unnecessary side effects."
With the knowledge that glucocorticoids aren't effective in treating bronchiolitis, future research should focus on finding other treatments and preventive strategies. One such strategy may involve a vaccine for the respiratory syncytial virus (RSV), which accounts for 50 to 80 percent of all bronchiolitis cases.
Kathy Shaw, M.D., chief of emergency medicine at Children's Hospital, and Kyle Nelson were other Hospital co-investigators on the study, which was published recently in The New England Journal of Medicine.