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

• Main Authors: Manal Bawazeer, Majed Aljeraisy, Esam Albanyan, Alanazi Abdullah, Wesam Al Thaqafi, Jaber Alenazi, Zaam Al otaibi, Mohammed Al Ghaihab
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2014-07-01
• Series: Avicenna Journal of Medicine
• Subjects: bronchiolitis; dexamethasone; salbutamol; albuterol; beta2 agonist; racemic; epinephrine; efficacy; randomized trial
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.4103/2231-0770.133333
• ISSN: 2231-0770; 2249-4464

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.