Effect of combined dexamethasone therapy with nebulized r-epinephrine or
salbutamol in infants with bronchiolitis: A randomized, double-blind, controlled
trial.
Author(s): Bawazeer M(1), Aljeraisy M(1), Albanyan E(1), Abdullah A(2), Al Thaqa W(1),
Alenazi J(1), Al Otaibi Z(3), Al Ghaihab M(1).
Affiliation(s): Author information:
(1)Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
(2)Department of Emergency Services, King Abdulaziz Medical City, Riyadh, Saudi
Arabia.
(3)Department of Respiratory Services, King Abdulaziz Medical City, Riyadh, Saudi
Arabia.
Publication date & source: 2014, Avicenna J Med. , 4(3):58-65
BACKGROUND: This study investigated the effect of combining oral dexamethasone
with either nebulized racemic epinephrine or salbutamol compared to
bronchodilators alone for the treatment of infants with bronchiolitis.
MATERIALS AND METHODS: This was a double-blind, randomized controlled trial on
infants (1 to 12 months) who were diagnosed in the emergency department with
moderate-to-severe bronchiolitis. The primary outcome was the rate of hospital
admission within 7 days of the first dose of treatment, and the secondary
outcomes were changes in respiratory distress assessment instrument score, heart
rate, respiratory rate, and oxygen saturation (O2 Sat) over a 4-hour observation
period. Infants (n = 162) were randomly assigned to four groups: A (dexamethasone
+ racemic epinephrine) = 45, B (placebo and racemic epinephrine) =39, C
(dexamethasone and salbutamol) = 40, or D (placebo and salbutamol) = 38.
RESULTS: Patients who had received dexamethasone + epinephrine exhibited similar
admission rates compared to placebo + epinephrine or salbutamol (P = 0.64).
Similarly, no statistically significant difference was observed in the rate of
hospitalization for patients who received dexamethasone + salbutamol compared to
those who received placebo + epinephrine or salbutamol (P = 0.51). Clinical
parameters were improved at the end of the 4-hour observation period for all
treatment groups. Treatment with dexamethasone + epinephrine resulted in a
statistically significant change in HR over time (P < 0.005) compared to the
other groups.
CONCLUSIONS: This study adds to a body of evidence suggesting that
corticosteroids have no role in the management of bronchiolitis for young infants
who are first time wheezers with no risk of atopy.
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