Efficacy of oral dexamethasone in outpatients with acute bronchiolitis☆☆☆★

Abstract 

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 ≥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. (J Pediatr 2002;140:27–32.)

Abbreviations:  ED , Emergency department, RDAI , Respiratory Disease Assessment Instrument, RACS , Respiratory Assessment Change Score