Respiratory :: Steroid medications not effective 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 from 21 hospitals that belong to 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.

“For any medical problem, and certainly for those involving young children, it is almost as important to know what does not work as what does, so that the physician does not expose the child to ineffective therapy and unnecessary side effects,” said Nathan Kuppermann, senior investigator of the study and professor of emergency medicine and pediatrics at UC Davis Health System. “With the size of our study, it’s pretty clear that steroids just aren’t an effective treatment for bronchiolitis for infants younger than one year. We need to search for other effective therapies, including a vaccine to prevent Respiratory Syncytial Virus (RSV), which is the most common cause of bronchiolitis.”

Bronchiolitis is the leading cause of hospitalization for infants in the United States and accounts for more than 100,000 admissions each year. RSV accounts for 50 to 80 percent of all bronchiolitis cases. Hospital charges associated with the disease exceed $700 million annually.

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.

Kuppermann said that the study provides solid evidence against the usefulness of one controversial therapy for this common illness. Current recommendations suggest that simple supportive care such as bulb suctioning of nasal secretions is the best available treatment for bronchiolitis.

“Steroids do play a very important in other pediatric respiratory illnesses such as asthma and croup,” added Kuppermann. “However, it is now seems clear that there is no apparent role for steroids in the treatment of infants 2-12 months of age with first-time wheezing, moderate-to-severe bronchiolitis.”

Glucocorticoid medications are not the androgenic steroids sometimes abused by athletes. Side effects seen with long-term steroid use are not a risk in the short-course treatments used for croup and asthma attacks.

Kuppermann also noted the benefits of a nationwide research network dedicated pediatric emergency care.

“This study demonstrates the power of a research network like PECARN to resolve the difficult-to-answer questions in our field,” said Kupperman. “The network is able to generate definitive research findings because of its size and substantial infrastructure, which enable it to conduct powerful and high-quality work.”

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. PECARN consists of four research nodal centers and a central data management and coordinating center.

The bronchiolitis study received funding from the Health Resources and Services Administration (HRSA) Research Program, as well as HRSA’s Emergency Medical Services for Children program.

The principal investigator on the study was Howard M. Corneli, professor of pediatrics at the University of Utah. Lead co-investigators were Joseph Zorc, an emergency physician at The Children’s Hospital of Philadelphia (CHOP), Prashant Mahajan, an emergency medicine physician at the Children’s Hospital of Michigan, and Kathy Shaw, chief of emergency medicine at CHOP.

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