Steroid medications don't work in treating lower respiratory infections in children

The use of steroid medication to treat bronchiolitis, a common viral lower respiratory infection in infants, does not prevent hospitalization or improve their respiratory symptoms, according to a study published in the July 26 issue of The New England Journal of Medicine.

The findings by the Pediatric Emergency Care Applied Research Network (PECARN) resolve controversy from prior research and are expected to help guide treatment for the most common cause of infant hospitalization.

The study compared hospitalization rates for 600 children between the ages of 2 months and 12 months who visited emergency rooms with moderate-to-severe bronchiolitis. Patients were treated with either a dose of dexamethasone (a glucocorticoid form of steroid medication) or a placebo and evaluated after one hour, and again at four hours. The hospital admission rate for both groups was identical at nearly 40 percent. Both groups improved during treatment, but the placebo group did as well as the group treated with active medication. The study was conducted in the emergency departments at 20 hospitals across the United States between November and April during a three-year period. Bronchiolitis is most common during the winter months.

"We learned that a commonly used treatment doesn't work," said Howard M. Corneli, M.D., professor of pediatrics at the University of Utah and the principal investigator on the study. "Now that we've demonstrated glucocorticoids aren't effective in treating bronchiolitis, we can focus our efforts on finding better treatments and better preventive strategies."

Bronchiolitis is the leading cause of hospitalization for infants in the United States and accounts for more than 100,000 admissions each year. Hospital charges associated with the disease exceed $700 million annually.

Corneli says the best solution to the problem of bronchiolitis might be to find a vaccine for the Respiratory Syncytial Virus (RSV) -- the most common cause of bronchiolitis. RSV accounts for 50 to 80 percent of all bronchiolitis cases.

Bronchiolitis infections begin most frequently with a fever, runny nose, coughing, and wheezing. Most children recover from the illness in eight to 15 days. The majority of children hospitalized for bronchiolitis infections are under 6 months old. Although many children with bronchiolitis have mild infections, and most don't need hospitalization, children born prematurely or who suffer from heart and lung disease are most at risk for complications.

"This study provides solid evidence to guide treatment of this common illness," said Joseph Zorc, M.D., an emergency physician at The Children's Hospital of Philadelphia (CHOP) and a lead co-investigator. "Current recommendations suggest that simple supportive care is the best available treatment for bronchiolitis. This study will help resolve some of the uncertainty for physicians and families and prevent unnecessary side effects."

Both physicians note that glucocorticoid medications still play an important role in other respiratory illnesses of childhood such as asthma and croup. They point out these medications are not the androgenic steroids sometimes abused by athletes, and that the side effects seen with long-term steroid use are not a risk in the short-course treatments used for croup and asthma attacks.

Nathan Kuppermann, M.D., a professor of emergency medicine and pediatrics at the University of California, Davis, chair of the PECARN network's steering committee, and the senior investigator of the study, stated, "This study also demonstrates the power of a research network like PECARN to resolve the difficult-to-answer questions in our field. The network is able to generate definitive research findings because of its size and substantial infrastructure to conduct high-quality work."