Combined Treatment May Offer Bronchiolitis Benefit

Epinephrine, dexamethasone linked to reduced hospitalization in infants after presentation
By Eric Metcalf
HealthDay Reporter

WEDNESDAY, May 13 (HealthDay News) -- The use of nebulized epinephrine and oral dexamethasone in infants presenting to emergency departments with bronchiolitis might reduce later hospital admission, according to research published in the May 14 issue of the New England Journal of Medicine.

Amy C. Plint, M.D., of the Children's Hospital of Eastern Ontario in Ottawa, Canada, and colleagues analyzed data from 800 infants -- 6 weeks to 12 months of age -- who presented to a pediatric emergency department with bronchiolitis. Children were randomized to receive either nebulized epinephrine along with doses of oral dexamethasone that started in the hospital and continued for five days at home; epinephrine and placebo; dexamethasone and placebo; or only placebo.

Infants in the epinephrine-dexamethasone group had a significantly lower risk of hospital admission within seven days, which was the primary outcome, compared to the placebo group (relative risk, 0.65). However, the epinephrine-dexamethasone finding lost significance after adjustment for multiple comparisons. Outcomes in the other treatment groups and the placebo group weren't significantly different. Adverse events were similar among the groups.

"What is the best way to treat wheezing in a preschooler? Although it is essential during the first episode to provide supportive care -- including supplemental oxygen, hydration, nutrition, and short-term bronchodilation -- the key intervention is close follow-up," write the authors of an accompanying editorial, who discuss the differences between episodic and unremitting wheezing.

A study co-author disclosed grant support from Cumberland Pharmaceuticals, and the editorial authors disclosed financial relationships with several relevant interests.

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