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COMMENTARY
QUESTION 2
DOES COMBINED ORAL DEXAMETHASONE
AND EPINEPHRINE INHALATION HELP
INFANTS WITH BRONCHIOLITIS TO
RECOVER FASTER?
SCENARIO
A 4-month-old girl with respiratory distress presents at the emergency room in
January. On physical examination the
child has a fever, nasal discharge and
a dry wheezy cough with tachypnoea
and dyspnoea. On auscultation you
nd inspiratory crackles and expiratory
wheezing. You know that there is no evidence for the use of bronchodilators or
corticosteroids in bronchiolitis, but you
wonder whether the combination of dexamethasone and epinephrine could help
your patient to recover more quickly.
Archimedes
Table 2
Does combined oral dexamethasone and epinephrine inhalation help infants with bronchiolitis to recover faster?
Citation
Study group
Study type
Outcome
Key results
Comments
Kuyucu et al9
RCT
Primary
outcomes:
clinical scores
(heart rate,
respiratory rate,
Respiratory
Distress
Assessment
Instrument (RDAI))
Secondary
outcomes:
respiratory
complaints
Bentur et al10
RCT
Plint et al11
RCT
Primary outcomes:
clinical scores
(respiratory rate,
wheezing, retraction, general
condition, oxygen
saturation), duration of supplemental oxygen, duration
of intravenous
fluids
Secondary outcomes: discharge
rate expressed
by proportion of
children in hospital and length of
hospitalisation
Primary outcome:
reduction in hospital admission at
7 days
Secondary outcomes: shortening
of time to discharge
and duration of
symptoms (eg,
respiratory rate,
heart rate)
Sufficient power
Long stay in ER (4 h)
No significant differences after
adjustment for unexpected synergistic effect
Large doses of dexamethasone
DEX, dexamethasone; dd, daily dose; ED, emergency department; EPI, epinephrine; inh, inhaled; NNT, number needed to treat; P, placebo; RDAI, Respiratory Distress
Assessment Instrument; RCT, randomised controlled trial; RR, respiratory rate; SAL, salbutamol; S, saline.
albuterol with prednisolone had a temporary effect,16 while in another study there
was no additional effect of dexamethasone in salbutamol-treated patients.17
Future studies should evaluate the combination of bronchodilators and steroids,
which is more widely available and safer.
In summary, Plint et al demonstrate
that treatment of viral bronchiolitis with
oral dexamethasone and epinephrine
inhalation is safe and effective in young
children and helps infants with bronchiolitis to recover faster. In this study, the
children spent at least 4 h in the emergency department, and the need for
hospitalisation was assessed after this
period. When implementing the results
of this study, it is important to consider
regional differences in the logistics of
Archimedes
Competing interests None.
Provenance and peer review Not commissioned;
internally peer reviewed.
Accepted 27 March 2011
Arch Dis Child 2011;96:606608.
doi:10.1136/archdischild-2011-300067
REFERENCES
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