RSV study debunks steroid use

A form of steroid that's often used to treat bronchiolitis, the most common reason that infants are hospitalized in America, doesn't work, according to a multicenter study led by the University of Utah Department of Pediatrics and Primary Children's Medical Center. The findings are published in the July 26 issue of The New England Journal of Medicine.

Research by the centers, all part of the Pediatric Emergency Care Applied Research Network, will likely guide treatment of the lower respiratory illnesses called bronchiolitis, most often caused by respiratory syncytial virus (RSV).

The researchers compared hospitalization rates during winter months over three years for 600 children 2 months to 12 months who visited emergency rooms with moderate to severe bronchiolitis. Infants were treated with either a dose of dexamethasone (a glucocorticoid form of steroid medication) or a placebo and evaluated an hour later, and again after four hours. The hospital admission rate for both groups was the same, at nearly 40 percent.

The results were "striking," said Dr. Howard M. Corneli, professor of pediatrics at the University of Utah and the principal investigator on the study. "Many of us thought the medication would work. But I think it's really important to know what doesn't work. Care has been so variable there's no clear evidence of what to do, so getting clear evidence that says we don't need to give this will be helpful."

Now research can focus on finding something that does work, he said.

More than 100,000 infant admissions are for bronchiolitis each year, with combined hospital charges of more than $700 million annually.

One problem has been wide variation in how physicians treat bronchiolitis, he said. There's wide disparity in how often the steroid — which is clearly effective to treat croup and asthma — has been used for bronchiolitis, according to studies in America and Canada. "Variable care is bad care and illogical care and expensive care," Corneli said.

He said the best solution might be to find a vaccine for RSV. But he emphasized that bronchiolitis is "usually not a very dangerous disease," although babies are miserable and parents worry and miss work because of it.

Bronchiolitis often begins with a fever, runny nose, coughing and wheezing. While most infants don't need to be hospitalized (most who do are under 6 months old), complications are most common in children born too soon or who have lung or heart disease.