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CC BY-NC-ND 4.0 · Avicenna J Med 2014; 04(03): 58-65
DOI: 10.4103/2231-0770.133333
ORIGINAL ARTICLE

Effect of combined dexamethasone therapy with nebulized r-epinephrine or salbutamol in infants with bronchiolitis: A randomized, double-blind, controlled trial

Manal Bawazeer
Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Majed Aljeraisy
Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Esam Albanyan
Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Alanazi Abdullah
Department of Emergency, King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Wesam Al Thaqafi
Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Jaber Alenazi
Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Zaam Al otaibi
Department of Respiratory Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Mohammed Al Ghaihab
Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Abstract

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 (O 2 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.

Keywords

Bronchiolitis - dexamethasone - salbutamol - albuterol - beta2 agonist - racemic - epinephrine - efficacy - randomized trial


Publikationsverlauf

Artikel online veröffentlicht:
09. August 2021

© 2014. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics 2006;118:1774-93.
  • 2 King VJ, Viswanathan M, Bordley WC, Jackman AM, Sutton SF, Lohr KN, et al. Pharmacologic treatment of bronchiolitis in infants and children: A systematic review. Arch Pediatr Adolesc Med 2004;158:127-37.
  • 3 Kellner JD, Ohlsson A, Gadomski AM, Wang EE. Efficacy of bronchodilator therapy in bronchiolitis. A meta-analysis. Arch Pediatr Adolesc Med 1996;150:1166-72.
  • 4 Kellner JD, Ohlsson A, Gadomski AM, Wang EE. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2000:CD001266.
  • 5 Flores G, Horwitz RI. Efficacy of beta2-agonists in bronchiolitis: A reappraisal and meta-analysis. Pediatrics 1997;100:233-9.
  • 6 Hartling L, Wiebe N, Russell K, Patel H, Klassen TP. A meta-analysis of randomized controlled trials evaluating the efficacy of epinephrine for the treatment of acute viral bronchiolitis. Arch Pediatr Adolesc Med 2003;157:957-64.
  • 7 Corneli HM, Zorc JJ, Mahajan P, Shaw KN, Holubkov R, Reeves SD, et al.Bronchiolitis Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med 2007;357:331-9.
  • 8 Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, et al.; Pediatric Emergency Research Canada (PERC). Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med 2009;360:2079-89.
  • 9 Kuyucu S, Unal S, Kuyucu N, Yilgor E. Additive effects of dexamethasone in nebulized salbutamol or L-epinephrine treated infants with acute bronchiolitis. Pediatr Int 2004;46:539-44.
  • 10 Bentur L, Shoseyov D, Feigenbaum D, Gorichovsky Y, Bibi H. Dexamethasone inhalations in RSV bronchiolitis: A double-blind, placebo-controlled study. Acta Paediatr 2005;94:866-71.
  • 11 Tal A, Bavilski C, Yohai D, Bearman JE, Gorodischer R, Moses SW. Dexamethasone and salbutamol in the treatment of acute wheezing in infants. Pediatrics 1983;71:13-8.
  • 12 Pauwels RA, Lofdahl CG, Postma DS, Tattersfield AE, O′Byrne P, Barnes PJ, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma. Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group. N Engl J Med 1997;337:1405-11.
  • 13 Barnes PJ. Scientific rationale for using a single inhaler for asthma control. Eur Respir J 2007;29:587-95.
  • 14 Giembycz MA, Kaur M, Leigh R, Newton R. A Holy Grail of asthma management: Toward understanding how long-acting beta (2)-adrenoceptor agonists enhance the clinical efficacy of inhaled corticosteroids. Br J Pharmacol 2008;153:1090-104.
  • 15 Schuh S, Coates AL, Binnie R, Allin T, Goia C, Corey M, et al. Efficacy of oral dexamethasone in outpatients with acute bronchiolitis. J Pediatr 2002;140:27-32.
  • 16 Roosevelt G, Sheehan K, Grupp-Phelan J, Tanz RR, Listernick R. Dexamethasone in bronchiolitis: A randomised controlled trial. Lancet 1996;348:292-5.
  • 17 Klassen TP, Sutcliffe T, Watters LK, Wells GA, Allen UD, Li MM. Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis: A randomized, controlled trial. J Pediatr 1997;130:191-6.
  • 18 Viswanathan M, King VJ, Bordley C, Honeycutt AA, Wittenborn J, Jackman AM, et al. Management of bronchiolitis in infants and children. Evid Rep Technol Assess (Summ) 2003:1-5.
  • 19 Garrison MM, Christakis DA, Harvey E, Cummings P, Davis RL. Systemic corticosteroids in infant bronchiolitis: A meta-analysis. Pediatrics 2000;105:E44.
  • 20 Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev 2010:CD004878.
  • 21 Schuh S, Coates AL, Dick P, Stephens D, Lalani A, Nicota E, et al. A single versus multiple doses of dexamethasone in infants wheezing for the first time. Pediatr Pulmonol 2008;43:844-50.
  • 22 Csonka P, Kaila M, Laippala P, Iso-Mustajarvi M, Vesikari T, Ashorn P. Oral prednisolone in the acute management of children age 6 to 35 months with viral respiratory infection-induced lower airway disease: A randomized, placebo-controlled trial. J Pediatr 2003;143:725-30.
  • 23 Somers CC, Ahmad N, Mejias A, Buckingham SC, Carubelli C, Katz K, et al. Effect of dexamethasone on respiratory syncytial virus-induced lung inflammation in children: Results of a randomized, placebo controlled clinical trial. Pediatr Allergy Immunol 2009;20:477-85.