Corticosteroid Treatment in Bronchiolitis

Leer, John A.; Green, John L.; Heimlich, Ernest M.; Hyde, John S.; Moffet, Hugh L.; Young, Gordon A.; Barron, Bruce

doi:10.1001/archpedi.1969.02100030497001

Cited by 102 publications

(14 citation statements)

References 12 publications

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“…10 16-29 Although some found a beneficial effect, 10 16-19 21 22 most well designed randomised controlled trials did not show that corticosteroids were beneficial. [23][24][25][26][27][28][29] Like other workers, in an earlier trial we were unable to show that oral prednisolone was beneficial in patients with mild RSV-LRTI. 10 However, prednisolone shortened the duration of mechanical ventilation and the LOS in hospital in a small group of patients on mechanical ventilation.…”

mentioning

confidence: 41%

Dexamethasone for treatment of patients mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus

Woensel

Aalderen²,

Weerd³

et al. 2003

Thorax

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Background: A study was undertaken to evaluate the efficacy of dexamethasone in patients mechanically ventilated for lower respiratory infection caused by respiratory syncytial virus (RSV-LRTI). Methods: In a multicentre randomised controlled trial patients were randomised to receive either intravenous dexamethasone (0.15 mg/kg 6 hourly for 48 hours) or placebo. End points were the duration of mechanical ventilation, length of stay (LOS) in the pediatric intensive care unit (PICU) and in hospital, and the duration of supplemental oxygen administration. Results: Thirty seven patients received dexamethasone and 45 received placebo. There was no significant difference in any of the end points between the two groups. In a post hoc analysis patients were stratified into those with mild gas exchange anomalies (PaO 2 /FiO 2 >200 mm Hg and/or mean airway pressure < 10 cm H 2 O, bronchiolitis group) and those with severe gas exchange anomalies (PaO 2 /FiO 2 <200 mm Hg and mean airway pressure >10 cm H 2 O, pneumonia group). In the 39 patients with bronchiolitis the duration of mechanical ventilation was 4.3 days shorter in the dexamethasone group than in the placebo group (4.9 v 9.2 days, 95% CI -7.8 to -0.8, p=0.02) and the duration of supplemental oxygen was 3.6 days shorter (7.7 v 11.3 days, 95% CI -8.0 to -0.1, p=0.048). No differences in end points were found in the pneumonia group. Conclusions: Dexamethasone had no beneficial effect in patients mechanically ventilated for RSV-LRTI but was found to have a beneficial effect in patients with bronchiolitis.

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mentioning

confidence: 41%

Dexamethasone for treatment of patients mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus

Woensel

Aalderen²,

Weerd³

et al. 2003

Thorax

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“…9,10,[12][13][14] The major limitation of this study is the nearly complete reliance on a clinical scoring system which is a subjective measure of outcome. However, obtaining objective measurements of respiratory system dysfunction in infants is difficult and may require sedation that may alter the results.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 While several studies have shown that corticosteroids have a short-term positive effect in bronchiolitis, 9 others have failed to demonstrate such benefits. [10][11][12] However, these studies suffer from various limitations, including a relatively small number of patients, inclusion of only severely ill infants requiring hospitalization, poor control of confounding variables, 9 lack of intergroup standardization between drug and placebo groups, 10,12 and lack of standardization for concomitant ␤2-agonist therapy. 9 In a recent publication, Klassen et al 13 demonstrated that oral dexamethasone was not effective as adjunctive therapy to 1 Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of corticosteroids in acute bronchiolitis: Short-term and long-term follow-up

et al. 1998

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“…1,71,72 A Cochrane database review on the use of glucocorticoids for acute bronchiolitis 71 included 13 studies. 37,50,64,[73][74][75][76][77][78][79][80][81][82] The 1198 patients showed a pooled decrease in length of stay of 0.38 days. However, this decrease was not statistically significant.…”

Section: Recommendation 3 Corticosteroid Medications Should Not Be Usmentioning

confidence: 99%

Diagnosis and Management of Bronchiolitis

2006

Pediatrics

885

293

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Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm.The American Academy of Pediatrics convened a committee composed of primary care physicians and specialists in the fields of pulmonology, infectious disease, emergency medicine, epidemiology, and medical informatics. The committee partnered with the Agency for Healthcare Research and Quality and the RTI International-University of North Carolina Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to the diagnosis, management, and prevention of bronchiolitis. The resulting evidence report and other sources of data were used to formulate clinical practice guideline recommendations.This guideline addresses the diagnosis of bronchiolitis as well as various therapeutic interventions including bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physiotherapy, and oxygen. Recommendations are made for prevention of respiratory syncytial virus infection with palivizumab and the control of nosocomial spread of infection. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent comprehensive peer review before it was approved by the American Academy of Pediatrics.This clinical practice guideline is not intended as a sole source of guidance in the management of children with bronchiolitis. Rather, it is intended to assist clinicians in decision-making. It is not intended to replace clinical judgment or establish a protocol for the care of all children with this condition. These recommendations may not provide the only appropriate approach to the management of children with bronchiolitis. INTRODUCTIONTHIS GUIDELINE EXAMINES the published evidence on diagnosis and acute management of the child with bronchiolitis in both outpatient and hospital settings, including the roles of supportive therapy, oxygen, bronchodilators, antiinflammatory agents, antibacterial agents, and antiviral agents and make recommendations to influence clinician behavior on the basis of the evidence. Methods of prevention All clinical practice guidelines from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of care. Variations, taking into account individual circumstances, may be appropriate. Key Word bronchiolitisAbbreviations CAM-complementary and alternative medicine LRTI-lower respiratory tract infection AHRQ-Agency for Healthcare Research and Quality RSV-respiratory syncytial virus AAP-American Academy of Pediatrics AAFP-American Academy...

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Corticosteroid Treatment in Bronchiolitis

Cited by 102 publications

References 12 publications

Dexamethasone for treatment of patients mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus

Dexamethasone for treatment of patients mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus

Efficacy of corticosteroids in acute bronchiolitis: Short-term and long-term follow-up

Diagnosis and Management of Bronchiolitis

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