Dexamethasone for Infants with Bronchiolitis and Risk for Asthma?

Katherine Bakes, MD

Infants with a history of eczema or family history of asthma had shorter time to discharge with dexamethasone than placebo.

In a prospective randomized, double-blind trial at a Qatar pediatric emergency center, investigators compared oral dexamethasone to placebo for the treatment of infants and children ≤18 months of age with moderate to severe bronchiolitis and risk for asthma; risk for asthma was defined as a history of eczema or a parent or sibling with asthma. All patients received nebulized salbutamol (2.5 mg); nebulized epinephrine (0.5 ml/kg) was administered at the treating physician's discretion.

During a 2-year period, 190 patients (median age, 3.5 months) received either placebo or dexamethasone (1mg/kg on day 1, followed by 0.6 mg/kg once daily for another 4 days). Median time to discharge readiness — no supplementary oxygen requirement; feeding well on own; minimal or absent wheezing, crackles, and chest retractions; oxygen saturations ≥94% — was shorter in the dexamethasone group (19 vs. 27 hours). The between-group difference in readiness for discharge was evident at 18 hours and disappeared by 48 hours. Fewer infants in the dexamethasone group received nebulized epinephrine (19% vs. 34%). There was no difference between groups in the proportion of patients requiring admission or making outpatient visits during the week after discharge.

CITATION(S):

Alansari K et al. Oral dexamethasone for bronchiolitis: A randomized trial. Pediatrics 2013 Sep 16; 132:e810.