Treating bronchiolitis with steroids doesn't work

For infants with a common and potentially serious viral lower respiratory infection called bronchiolitis, a widely used steroid treatment is not effective.

A new study co-authored by Dr. Joan Bregstein of the Morgan Stanley Children's Hospital of NewYork-Presbyterian and Columbia University Medical Center found that steroid treatment did not prevent hospitalization or improve respiratory symptoms for bronchiolitis, the most common cause of infant hospitalization. Bronchiolitis symptoms frequently include fever, runny nose, coughing and wheezing.

The multicenter study, conducted by the Pediatric Emergency Care Applied Research Network (PECARN), is published in the July 26 New England Journal of Medicine.

"Our study shows that treating bronchiolitis with steroids doesn't work. We hope this study will resolve some of the uncertainty for physicians and families, as we move forward in developing better means of preventing and treating the infection," says Dr. Bregstein, site principal investigator and emergency medicine pediatrician at Morgan Stanley Children's Hospital of NewYork-Presbyterian and assistant clinical professor of pediatrics at Columbia University College of Physicians and Surgeons.

Current recommendations suggest that simple supportive care is the best available treatment for bronchiolitis. Researchers note that steroid-based 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.

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 three-year study was conducted in the emergency departments at 20 hospitals across the United States.

Most children recover from the illness in eight to 15 days. The majority of children hospitalized for bronchiolitis 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.

The study received funding from the Health Resources and Services Administration (HRSA) Emergency Medical Services for Children (EMSC) program. The PECARN network is funded with cooperative agreements from HRSA as part of the EMSC program. The network includes 21 affiliated hospitals and their emergency departments and conducts multi-institutional research in the prevention and management of acute illnesses and injuries in children.

The study was led for PECARN by the University of Utah's Department of Pediatrics and Primary Children's Medical Center in Salt Lake City.