NEW YORK (Reuters Health) – Treatment with epinephrine and dexamethasone in the emergency room may help infants with bronchiolitis avoid hospital admission, according to a report in the May 14th issue of The New England Journal of Medicine. However, according to a related editorial, the effect is modest and may not be worth the risk.

Prior research has examined the benefits of nebulized epinephrine or corticosteroid monotherapy at improving bronchiolitis outcomes, but few studies have looked at the impact of combining these agents, lead author Dr. Amy C. Plint, from the Children’s Hospital of Eastern Ontario, Canada, and colleagues note.

The researchers studied 800 infants seen at pediatric emergency departments who were randomized to receive nebulized epinephrine, oral dexamethasone, both, or neither.

Epinephrine was given as two treatments in the emergency department, dexamethasone was given as six oral doses in the emergency department plus five daily doses subsequently. Placebo formulations were used to ensure blinding in the groups that did not receive both active treatments.

The main outcome was hospitalization within 7 days of the visit to the emergency room.

By 7 days, 17.1% of infants given both active agents had been admitted to the hospital compared with 23.7%, 25.6%, and 26.4% of infants given epinephrine-only, dexamethasone-only, or placebo-only, respectively.

On initial analysis, subjects in the combined-drug group were the only ones that were significantly less likely than the placebo-only group to be hospitalized (RR = 0.65, p = 0.02). On multivariate analysis, however, this findings fell short of statistical significance (p = 0.07).

“Given the small effect size of the study — 11 infants would have to be treated to prevent one hospital admission — it does not seem practical to apply the treatment, especially considering the potential effects of high-dose corticosteroids on brain and lung development in such young children,” Dr. Urs Frey, from the University Hospital of Bern, Switzerland, and Dr. Erika von Mutius, from University Children’s Hospital, Munich, Germany, comment in an accompanying editorial.

Reference:
N Engl J Med 2009;360:2079-2089,2130-2133.