Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis: A randomized, controlled trial

Klassen, Terry P; Sutcliffe, Teresa; Watters, Lise K.; Wells, George A.; Allen, Upton; Li, Marilyn M.

doi:10.1016/s0022-3476(97)70342-1

Cited by 138 publications

(88 citation statements)

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“…6 -12 The mean duration of hospitalization 6,7,9,10 and the frequency of respiratory support were equal to those of the other studies. 6,7,11 The frequency of hospitalization of infants 0 to 2 years of age with RSV infection is 1.4% in our study. This is comparable to the Finnish figures cited by Ruuskanen and Ogra, 1 although similar figures are not mentioned in the studies listed in Table 5.…”

Section: Discussionsupporting

confidence: 43%

“…11 In 2 studies infants with earlier episodes of wheezing were excluded. 7,8 Seriously ill infants who required admission to the intensive care unit also were excluded in 2 of the studies. 8,12 Only in 1 study were tests of lung function performed.…”

Section: Discussionmentioning

confidence: 99%

“…The reproducibility of the clinical score was only studied in 2 of the reports in Table 5. 7,8 We decided against using a clinical score for following reasons: it is difficult to design a study with clinical scoring that is not affected by the treatment given, especially in the form of respiratory support, and clinical scoring is only a proxy variable, the variables of real interest being time to resolution and long-term morbidity.…”

Section: Discussionmentioning

confidence: 99%

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Prednisolone Treatment of Respiratory Syncytial Virus Infection: A Randomized Controlled Trial of 147 Infants

et al. 1999

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ABSTRACT. Objective. To evaluate the effect of systemic prednisolone as an adjunct to conventional treatment with ␤2-agonist, respiratory support, and fluid replacement in hospitalized infants <24 months of age with respiratory syncytial virus (RSV) infection.Methods. The study was randomized, double-blind, and placebo-controlled. During the winter of 1995-1996, 147 infants <2 years of age, hospitalized with RSV infection, were allocated to treatment with either systemic prednisolone mixture 2 mg/kg daily or placebo for 5 days.Main Outcome Measures. The acute effect variables were duration of stay in hospital, use of medicine, and supportive measures while in hospital. At follow-up 1 month after discharge, the acute effect variables were duration of illness, start in day care center, morbidity, and use of medicine. At follow-up 1 year after discharge, the acute effect variables were morbidity, use of medicine, and skin prick tests with allergens.Results. Prednisolone treatment had no effect on any of the outcome measures.Conclusions. Our randomized prospective study in infants hospitalized with acute RSV infection showed no effect of systemic prednisolone treatment either in the acute state of RSV infection, nor in the follow-up 1 month and 1 year after admission to hospital. We find our results in agreement with the largest studies reported earlier; therefore, corticosteroid, whether by the systemic route or by inhalation, should not be prescribed to infants with RSV infection. Pediatrics 1999;104(6). URL: http://www.pediatrics.org/cgi/content/full/104/6/e77; infants, respiratory syncytial virus, prednisolone, corticosteroids, treatment, randomized controlled trial.ABBREVIATIONS. RSV, respiratory syncytial virus; IV, intravenous; CPAP, continuous positive airway pressure. P revious studies have shown that a majority of infants are infected with respiratory syncytial virus (RSV) during their first or second year of life.1 However, only a minority of these children are admitted to hospital. 2Because of many clinical and presumed pathophysiological similarities between RSV infection and asthma, corticosteroid has been used widely for treatment of RSV infections. [3][4][5] Of the reports of randomized, controlled studies of systemic corticosteroid treatment of RSV infection in infants, 7 have shown conflicting results.6 -12 However, these studies are not directly comparable because of the differences of diagnostic criteria, exclusion criteria, and measures of effect.This study investigates the short-term and longterm effects of systemic corticosteroid treatment in a large, unselected group of infants hospitalized with RSV infection. METHODSThe 3 participating pediatric departments serve the County of Copenhagen and 1 neighboring county with a joint population of ϳ34 000 infants Ͻ2 years of age. A total of 147 hospitalized infants were included prospectively between November 1995 and April 1996. Inclusion CriteriaPatients Ͻ2 years of age hospitalized with respiratory infection and a positive RSV test were included i...

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Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prednisolone Treatment of Respiratory Syncytial Virus Infection: A Randomized Controlled Trial of 147 Infants

et al. 1999

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“…Children were classified as having "severe" bronchiolitis if their condition was deemed by the attending paediatrician and intensivist to merit PICU admission for positive-pressure mechanical ventilator support and classified as "moderate" severity if the child was cared for on a standard inpatient ward. To further validate this classification, disease severity was also measured using a clinical score known as the Respiratory Distress Assessment Instrument (RDAI) [20]. The RDAI was calculated at the point of enrolment of each case by the same investigator (T.R.L.).…”

Section: Study Proceduresmentioning

confidence: 99%

Interleukin-15 is associated with disease severity in viral bronchiolitis

et al. 2015

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Disease severity in viral bronchiolitis in infancy is difficult to predict and has been linked to host innate immunity. The study aimed to investigate the innate cytokine interleukin-15 (IL-15) as a marker of disease severity.A prospective single-centre observational study was conducted in a university-affiliated paediatric teaching hospital, comparing children (0-18 months) hospitalised for viral bronchiolitis, those admitted to the paediatric intensive care unit with severe disease and healthy age-matched controls. IL-15-related parameters were compared between groups. PCR and microRNA (miRNA) sequencing was undertaken on natural killer (NK) cells collected from study participants.Samples from 88 children with viral bronchiolitis and 43 controls enrolled between 2009 and 2012 were analysed. Peripheral blood mononuclear cell (PBMC) IL-15 mRNA expression was significantly higher in those with moderate severity bronchiolitis compared with controls and those with severe disease. Serum IL-15 levels correlated with disease severity. The relative frequency of NK cells in peripheral blood was significantly reduced in participants with bronchiolitis. The NK cell miRNA transcriptome in bronchiolitis was distinct. Targets of de-regulated miRNA were differentially expressed in bronchiolitis, including JAK3, STAT5A and NFKB1 on the IL-15 signalling pathway.IL-15 is associated with disease severity in children hospitalised with viral bronchiolitis.@ERSpublications Interleukin-15 influences the host innate response and is associated with disease severity in viral bronchiolitis

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“…[7][8][9][10] Although a recent meta-analysis demonstrated an association between corticosteroid use and a decrease in length of hospital stay by 0.4 days, 11 recent large clinical trials leave little optimism regarding corticosteroid use in bronchiolitis. [12][13][14][15][16][17] In contrast, a number of trials, reviews, and a meta-analysis suggest that a subpopulation of infants with bronchiolitis benefit from ␤-agonists administration. 18 -22 These data, however, are balanced with a meta-analysis and several trials that fail to show any effects.…”

mentioning

confidence: 99%

Bronchiolitis Management Preferences and the Influence of Pulse Oximetry and Respiratory Rate on the Decision to Admit

et al. 2003

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ABSTRACT. Objective. High incidence, rising admission rates, and relatively ineffective therapies make the management of bronchiolitis controversial. Since 1980, the rate of hospitalization for children with bronchiolitis has increased by nearly 250%, whereas mortality rates for the disease have remained constant. It has been speculated that the increasing use of pulse oximetry has lowered the threshold for admission and may have contributed to the rise in bronchiolitis-related admissions. The objective of this study was to describe pediatric emergency medicine physicians' management preferences regarding infants with moderately severe bronchiolitis and to assess the influence of specific differences in oxygen saturation as measured by pulse oximetry (SpO 2 ) and respiratory rate (RR) on the decision to admit.Methods. Physicians who are members of the American Academy of Pediatrics Section of Emergency Medicine and living in the United States were randomized into 4 groups and mailed a survey that contained 1 of 4 vignettes. Vignettes were identical except for given SpO 2 values (94% or 92%) and RR (50/min or 65/min). Subjects were asked to answer questions regarding laboratory tests, treatment options, and the decision to admit for the patient in their vignette.Results. We received completed surveys from 519 (64%) of the 812 physicians contacted. Most respondents recommended use of bronchodilators (96%), nasal suction (82%), and supplemental oxygen (57%). Few respondents recommended decongestants (9%), steroids (8%), or antibiotics (2%). When asked to rank therapies, respondents gave nasal suction 182 number 1 votes; bronchodilators received 164. The decision to admit varied with SpO 2 and RR. Forty-three percent of respondents who received a vignette featuring SpO 2 of 94% and a RR of 50/min recommended admission for the infant in their vignette. Fifty-eight percent recommended admission when the vignette SpO 2 was 94% and RR was 65/min ( 2 ‫؍‬ 5.021). Respondents who received a vignette with SpO 2 of 92% were nearly twice as likely to recommend admission: 83% recommended admission when vignette RR was 50/min, and 85% recommended admission when vignette RR was 65/min ( 2 ‫؍‬ 0.126).Conclusions. When treating infants with moderately severe bronchiolitis, pediatricians who work in emergency departments frequently use bronchodilators and nasal suction, 2 practices for which supporting data are either conflicting (bronchodilators) or nonexistent (nasal suction). In addition, their decisions to admit differ markedly on the basis of only a 2% difference in SpO 2 . It is possible that increased reliance on pulse oximetry has contributed to the increase in bronchiolitis hospitalization rates seen during the past 2 decades. Pediatrics 2003;111:e45-e51. URL: http://www.pediatrics.org/cgi/ content/full/111/1/e45; bronchiolitis, bronchodilators, steroids, nasal suction, pulse oximetry, practice variation.ABBREVIATIONS. Spo 2 , oxygen saturation as measured by pulse oximetry; RR, respiratory rate; RSV, respiratory syncytial...

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Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis: A randomized, controlled trial

Cited by 138 publications

References 21 publications

Prednisolone Treatment of Respiratory Syncytial Virus Infection: A Randomized Controlled Trial of 147 Infants

Prednisolone Treatment of Respiratory Syncytial Virus Infection: A Randomized Controlled Trial of 147 Infants

Interleukin-15 is associated with disease severity in viral bronchiolitis

Bronchiolitis Management Preferences and the Influence of Pulse Oximetry and Respiratory Rate on the Decision to Admit

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