Source:Csonka P, Kaila M, Laippala P, et al. Oral prednisolone in the acute management of children age 6 to 35 months with viral respiratory infection-induced lower airway disease: a randomized placebo-controlled trial.
J Pediatr

Although bronchiolitis is a self-limiting disease for most patients, some have prolonged symptoms and require hospitalization. The use of steroids in the acute management of bronchiolitis in infants and young children remains controversial. Therefore, investigators at the Pediatric Research Center, Tampere University Hospital in Tampere, Finland completed a randomized, double-blind, placebo-controlled study on 230 children, age 6 to 35 months, who were seen in the emergency department (ED) with acute wheezing, tachypnea, or use of accessory respiratory muscles in the presence of an apparent viral respiratory infection (rhinorrhea or temperature >37.5°C). Patients with asthma were excluded. Eligible patients were randomized to receive either 2 mg/kg of oral prednisolone in the ED and 1 mg/kg twice daily for 3 more days, or an equivalent amount of placebo. Hospitalization and the use of other bronchodilator medications were at the discretion of the attending physicians.

The primary outcome measured was development of severe respiratory symptoms that required additional asthma medications. Secondary outcomes included hospitalization rate from the ED, hospital length of stay, long hospitalizations (≥3 days), and duration of symptoms. There was no difference in hospitalization rate between the 2 groups, with 53% of placebo patients and 54% of prednisolone patients requiring admission. Of the hospitalized patients, a larger number who received placebo needed additional asthma medications (39%) than those that received prednisolone (19%, P=.018). Median length of stay in the hospital was shorter in the prednisolone group (2.0 versus 3.0 days, P=.06), and fewer prednisolone patients required prolonged hospitalizations (47.5% versus 67.7%, P=.023). Median duration of symptoms was also less in the prednisolone group (1.0 versus 2.0, P<.001).

Several studies have been published on the effectiveness of steroids in bronchiolitis, and they have led to varying conclusions.1–,5 A recent study of ED patients who received 1 mg/kg of dexamethasone or placebo showed a lower hospitalization rate in the steroid group (19% versus 44%).1 Other studies including a meta-analysis have shown significant improvement in symptoms and length of hospitalization when steroids are provided to patients with bronchiolitis.2,3 However, there are other published trials of steroid use in bronchiolitis that showed no efficacy.4,5 

The current study adds further evidence that steroids provide a significant benefit to patients with bronchiolitis. However, there are some methodologic features of the present study that require careful consideration. Despite the authors’ attempts to concentrate on "a relatively homogenous group of children," the lack of viral testing most likely resulted in the inclusion of a heterogenous group of study subjects. Enrollment included patients up to age 35 months, with a mean age of over 16 months in both randomized groups. This represents an older study population than most other studies. This study also included patients that...

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