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Best Evidence Topic reports
Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary

https://doi.org/10.1136/emj.2008.066886

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    ORAL STEROIDS ARE NOT INDICATED IN BRONCHIOLITIS

    Report by: Jayachandran Panickar, Consultant Respiratory Paediatrician

    Search checked by: Michael Eisenhut, Consultant Paediatrician

    Institution: Central Manchester and Manchester Children’s University Hospital and Luton and Dunstable Hospital

    A short-cut review was carried out to establish whether steroids are indicated in the management of bronchiolitis. Six papers presented evidence addressing the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that oral steroids are not indicated in bronchiolitis.

    Three-part question

    In [infants with bronchiolitis] do [oral steroids] reduce [clinical severity or length of hospital stay].

    View this table:
    Table 1 Relevant papers

    Clinical scenario

    A 6-month-old baby is admitted to hospital with a 4-day history of coryzal symptoms, cough, wheeze and decrease in feeds. Respiratory syncytial virus is detected in nasopharyngeal secretions. She is needing oxygen and is on a nasogastric feed. You wonder whether starting oral steroids will improve her clinical condition.

    Search strategy

    Medline 1966–2008 Embase 1980–2008 Cochrane database of systematic reviews and Cochrane central register of controlled trials (Oral steroids or prednisolone) AND (bronchiolitis or RSV bronchiolitis) limit to human, english and randomised controlled trials.

    Search outcome

    There was a total of 35 hits, with six relevant papers.

    Comments

    The largest of the studies (Corneli et al) was conducted in the emergency department. Neither the primary outcome measure (hospital admission) nor the secondary outcomes (length of hospital stay and clinical score) showed any significant improvement with steroids. In the first 2 days of treatment prednisolone seems to accelerate the improvement of clinical scores transiently without impact on overall outcomes, such as duration of hospitalisation or chronic symptoms.

    Zhang L, Ferruzzi E, Bonfanti T, . Long and short-term effect of prednisolone in hospitalized infants with acute bronchiolitis J Paediatr Child Health 2003;39:548–51.

    Corneli HM, Zorc JJ, Majahan P, . of the Bronchiolitis Study Group of the Pediatric Emergency Care Applied Reserach Network (PECARN). A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med 2007;357:331–9.

    Berger I, Argaman Z, Schwartz SB, . Efficacy of corticosteroids in acute bronchiolitis: short term and long term follow up. Pediatr Pulmonol 1998;26:162–6.

    Goebel J, Estrada B, Quinonez J, . Prednisolone plus albuterol versus albuterol alone in mild to moderate bronchiolitis. Clin Pediatr 2000;39:213–20.

    Klassen TP, Sutcliffe T, Watters LK, . Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis: a randomised controlled trial. J Pediatrics 1997;130:191–6.

    van Woensel JB, Wolfs TF, van Aalderen WM, . Randomised double blind placebo controlled trial of prednisolone in children admitted to hospital with respiratory syncytial virus bronchiolitis. Thorax 1997;52:634–7.