title: A single versus multiple doses of dexamethasone in infants wheezing for the first time.
abstract: BACKGROUND
  Corticosteroid therapy is not routinely recommended in true bronchiolitis. However, since bronchiolitis and the first asthma attack are impossible to distinguish, some infants with the first wheezing episode receive corticosteroids. Optimal duration of corticosteroid therapy in this scenario is unknown. This study compared efficacy of multiple administrations and a single dose of dexamethasone in bronchiolitis.
  
  
  METHODS
  In this randomized double blind trial, previously healthy outpatients 2-23 months of age with bronchiolitis and Respiratory Disease Assessment Instrument (RDAI) score 6 or more received 1 mg/kg of oral dexamethasone in the Emergency Department. Prior to discharge at 4 hr they were randomized to either 4 daily doses of dexamethasone 0.15 mg/kg or placebo equivalent. Primary outcome was the proportion of subsequent hospitalizations or prescribed trials of bronchodilator/corticosteroid therapy for dyspnea by day 6 in the groups. Secondary outcomes were changes in the RDAI to day 6, and proportions with unscheduled visits by days 6 and 28.
  
  
  RESULTS
  The rate of primary outcome in the single dose group (SDG, N = 64) was 9/64 or 14.1% versus 7/61 or 11.5% in the multiple dose group (MDG, N = 61) [95% CI 0.09; 0.14]. Twelve (18.8%) children in the SDG had unscheduled medical visits by day 6 versus 11 (18.0%) children in the MDG [95% CI 0.13; 0.14]. On day 6 the RDAI decreased from 9.5 +/- 2.1 to 2.1 +/- 2.4 in the SDG and from 9.8 +/- 2.2 to 1.6 +/- 2.3 in the MDG [95% CI 0.36; 2.06]. Between days 7-28, 24/64 (37.5%) SDG infants returned for care versus 20/61 (32.8%) of the MDG [95% CI 0.12; 0.21].
  
  
  CONCLUSIONS
  Our study suggests that, in outpatients with bronchiolitis who receive dexamethasone, continuation of this agent beyond the initial dose does not provide significant benefit.
authors.affiliation: Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON, Canada. suzanne.schuh@sickkids.ca
authors.forename: Suzanne
authors.initials: S
authors.lastname: Schuh
authors.forename: Allan L
authors.initials: AL
authors.lastname: Coates
authors.forename: Paul
authors.initials: P
authors.lastname: Dick
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.forename: Amina
authors.initials: A
authors.lastname: Lalani
authors.forename: Erika
authors.initials: E
authors.lastname: Nicota
authors.forename: Matthew
authors.initials: M
authors.lastname: Mokanski
authors.forename: Svetlana
authors.initials: S
authors.lastname: Khaikin
authors.forename: Upton
authors.initials: U
authors.lastname: Allen
mesh_terms: D001988:Bronchiolitis / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D008297:Male; D012135:Respiratory Sounds / Q000187:drug effects*; D013997:Time Factors
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone