Reducing Hosp. - Bronchiolitis
Submitted by Administrator on Thu, 2009-07-02 09:30
The following is inconclusive, but it is interesting to discuss it in an exploratory way—if safety is born out,* synergistic use Dexamethasone (per oral) and epinephrine via a nebulizer may aid in the treatment of wheezing conditions, exacerbated by viral infection of the lung parenchyma
* Arrest of somatic growth, neurodevelopmental delay, or adrenal suppression
Indeed, the combination may "reduce hospital admission, hasten discharge from the emergency department, and decrease the duration of symptoms in infants with bronchiolitis."
However, either drug given alone did not have much benefit. Furthermore, 11 infants would have to be treated to prevent one hospitalization, therefore it may be premature to recommend this treatment, especially considering the potential risk from using even short course high-dose corticosteroids in such young children.
Plint AC, Johnson DW, Patel H, et al. "Epinephrine and Dexamethasone in Children with Bronchiolitis." N. Engl. J. Med. 2009;360:2130–1) [Free Full Text].
In "The Challenge of Managing Wheezing in Infants [subscription required], Frey and von Mutius, suggest, instead of knee jerk use of powerful drugs in an infant or young child that in the first episode of bronchiolitis, provide supportive care such as supplemental oxygen, hydration and/or short-term bronchodilation, if indicated and the patient is responsive.
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