Bronchiolitis: progress at last?

The majority of infants with bronchiolitis do well. I suspect that few parents of infants with bronchiolitis seek care and of those that do, the majority are reassured and sent home. However, for the infant who makes it to the emergency department or is actually hospitalised, few therapies are effective. Virtually all guidelines indicate that neither bronchodilators nor steroids are helpful. However four recent studies address new approaches to treatment. In a well done multi-site Canadian study, 800 infants with bronchiolitis who were seen in a paediatric emergency department were randomized to one of four groups: two treatments of nebulized epinephrine and six oral doses of dexamethasone; nebulized epinephrine and oral placebo; nebulized placebo and oral dexamethasone; and nebulized and oral placebos.1 They found that infants who received both epinephrine and steroids were significantly less likely to be admitted (17.1%) within seven days of being seen than any of the other three groups. The number needed to treat is approximately 12. The one concern in this study was that the admission rate in the three …