title: Effect of combined dexamethasone therapy with nebulized r-epinephrine or salbutamol in infants with bronchiolitis: A randomized, double-blind, controlled trial.
abstract: BACKGROUND
  This study investigated the effect of combining oral dexamethasone with either nebulized racemic epinephrine or salbutamol compared to bronchodilators alone for the treatment of infants with bronchiolitis.
  
  
  METHODS
  This was a double-blind, randomized controlled trial on infants (1 to 12 months) who were diagnosed in the emergency department with moderate-to-severe bronchiolitis. The primary outcome was the rate of hospital admission within 7 days of the first dose of treatment, and the secondary outcomes were changes in respiratory distress assessment instrument score, heart rate, respiratory rate, and oxygen saturation (O2 Sat) over a 4-hour observation period. Infants (n = 162) were randomly assigned to four groups: A (dexamethasone + racemic epinephrine) = 45, B (placebo and racemic epinephrine) =39, C (dexamethasone and salbutamol) = 40, or D (placebo and salbutamol) = 38.
  
  
  RESULTS
  Patients who had received dexamethasone + epinephrine exhibited similar admission rates compared to placebo + epinephrine or salbutamol (P = 0.64). Similarly, no statistically significant difference was observed in the rate of hospitalization for patients who received dexamethasone + salbutamol compared to those who received placebo + epinephrine or salbutamol (P = 0.51). Clinical parameters were improved at the end of the 4-hour observation period for all treatment groups. Treatment with dexamethasone + epinephrine resulted in a statistically significant change in HR over time (P < 0.005) compared to the other groups.
  
  
  CONCLUSIONS
  This study adds to a body of evidence suggesting that corticosteroids have no role in the management of bronchiolitis for young infants who are first time wheezers with no risk of atopy.
authors: Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors: Manal
authors: M
authors: Bawazeer
authors: Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors: Majed
authors: M
authors: Aljeraisy
authors: Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors: Esam
authors: E
authors: Albanyan
authors: Department of Emergency Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors: Alanazi
authors: A
authors: Abdullah
authors: Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors: Wesam
authors: W
authors: Al Thaqa
authors: Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors: Jaber
authors: J
authors: Alenazi
authors: Department of Respiratory Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors: Zaam
authors: Z
authors: Al Otaibi
authors: Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors: Mohammed
authors: M
authors: Al Ghaihab
keywords: Bronchiolitis; albuterol; beta2 agonist; dexamethasone; efficacy; epinephrine; racemic; randomized trial; salbutamol