The Effectiveness of Dexamethasone as Adjunctive Therapy to Racemic Epinephrine for a Pediatric Patient With Bronchiolitis

摘要

Background: Bronchiolitis is a lower respiratory tract infection that is most common in the pediatric population, and is the major cause of hospitalizations for patients in their first year of life. Despite the prevalence of this disease, a consensus for optimal treatment is elusive. Although numerous studies have addressed dexamethasone or epinephrine alone, the combination is not well established. The optimal therapeutic management of bronchiolitis is still controversial. The objective of this literature review is to determine the effectiveness of the combination of dexamethasone and epinephrine in pediatric patients with bronchiolitis.Methods: A systematic review from 1990 to the present of English-language published literature was conducted using MEDLINE, CINAHL, and ISI Web of Science, Evidence Based Medicine Reviews Multifile, and Google Scholar using keywords bronchiolitis, and dexamethasone, and epinephrine. Articles of original research examining outcomes of the management of bronchiolitis with dexamethasone and epinephrine versus placebo and epinephrine versus placebo. Meta-analyses and case reports or series were excluded. Fifteen studies, three of which compared combination therapy of dexamethasone and epinephrine therapy to placebo were retrieved and analyzed for quality and significant results.Results: The three studies that were reviewed indicate that there is a significant positive effect of the combination therapy of dexamethasone and epinephrine in the management of bronchiolitis. There is a synergistic effect between dexamethasone and epinephrine that has been shown to decrease the rate of hospital admission and length of hospital stay in the three studies included in this systematic review.Discussion: Current guidelines suggest tailoring the treatment of bronchiolitis based on the presentation of symptoms. Although the American Academy of Pediatrics has produced a manuscript for the diagnosis and management of bronchiolitis, it gives an overview of available treatment modalities without a consensus on optimal treatment. Additional prospective research efforts, perhaps even larger, multi-center, randomized placebo-controlled trials, are needed to quantify and qualify possible risks of combination therapy of dexamethasone with epinephrine in the pediatric population. Such work should be on large population with a broader age range (2 months to 5 years), and should include patients who are both first-time wheezers, and recurrent wheezers. Lastly, research should be performed on the long-term effects of corticosteroid therapy in the pediatric population.