Steroids Won't Help Common Respiratory Infection in Infants

WEDNESDAY July 25, 2007 -- A commonly prescribed steroid called dexamethasone is no more effective in infants with the lower respiratory tract infection bronchiolitis than a placebo, new research suggests.

The study found no statistically significant differences in the rates of hospitalization and in measures of respiratory health between a group of infants given dexamethasone, which can incur side effects, and a group given a placebo.

"For young infants with bronchiolitis with first-time wheezing, we'd hope that the results of this study would lead physicians not to use corticosteroids," said the study's senior author, Dr. Nathan Kuppermann, chairman of the department of emergency medicine at the University of California, Davis. "Why incur the risk of side effects if the medication isn't effective?"

Results of the study are published in the July 26 issue of the New England Journal of Medicine.

Kuppermann was quick to point out that this study's findings do not mean that corticosteroids don't have a place in the treatment of other airway diseases. For example, corticosteroids are an often-used and effective treatment for asthma.

Bronchiolitis is a common respiratory infection in children and is the leading cause of hospitalizations for infants in the United States. Each year, as many as 100,000 infants are hospitalized due to bronchiolitis, according to the study. There are numerous causes of bronchiolitis, and one of the most common is infection with respiratory syncytial virus (RSV).

Treatment options for bronchiolitis are few, and the most common care provided by doctors or hospitals is supportive care, such as extra oxygen. Because corticosteroids are an effective treatment for other respiratory diseases, doctors have used these drugs to treat bronchiolitis as well, although past research hasn't provided clear evidence that they work.

To answer the question of whether or not dexamethasone is helpful for bronchiolitis in the youngest patients, Kuppermann and his colleagues from the Pediatric Emergency Care Applied Research Network conducted a double-blind, randomized study that included 600 children between the ages of 2 and 12 months.

Half of the children were given a single dose of oral dexamethasone (1 milligram per kilogram of body weight), and half of the children received an oral placebo.

Forty percent of babies on dexamethasone had to be hospitalized, compared to 41 percent of those on the placebo. Both groups also saw similar improvements in breathing. And, there was no difference in later outcomes, the study found.

"If a young infant between 2 and 12 months of age presents to the emergency department with first-time wheezing in the wintertime, I would argue that it would be safer not to give steroids than to give them," Kupperman said.

"Sometimes it's just as important to identify medications that aren't effective as it is to identify those that are. We don't want to subject anyone, particularly infants, to unnecessary risks," said Kuppermann.

However, Kuppermann acknowledged that in real-life practice, physicians may still use corticosteroids because there are no reliable alternatives to treat bronchiolitis, and because it can sometimes be difficult to tell in infants whether wheezing is caused by bronchiolitis or asthma.

"These are tiny babies, wheezing and huffing. Can the physician do nothing? The majority of babies do get treatment, despite the fact that these treatments don't appear to be of value," said Dr. Caroline Hall, an infectious-disease specialist at the University of Rochester School of Medicine and Dentistry in New York, and the author of an accompanying editorial in the journal.

"But, we wouldn't want to give something that as far as we know has no effect, because there's always a potential for side effects. No specific drug has been shown to help in bronchiolitis," said Hall, who added, "The best therapy that we know is good supportive, clinical care."

And, Kuppermann pointed out that despite a lack of effective treatments, most babies with bronchiolitis do well and will get better on their own.

More information

To learn more about bronchiolitis, visit the Nemours Foundation.

Posted: July 2007


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