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A 4-month-old girl with respiratory distress presents at the emergency room in January. On physical examination the child has a fever, nasal discharge and a dry wheezy cough with tachypnoea and dyspnoea. On auscultation you find inspiratory crackles and expiratory wheezing. You know that there is no evidence for the use of bronchodilators or corticosteroids in bronchiolitis, but you wonder whether the combination of dexamethasone and epinephrine could help your patient to recover more quickly.
Structured clinical question
In infants with bronchiolitis [patients], does a combination of dexamethasone and epinephrine [intervention] reduce respiratory symptoms and speed up recovery [outcome]?
Search strategy and outcome
We searched the Cochrane Library for systematic reviews and PubMed for randomised controlled trials (RCTs). MeSH terms were used in PubMed. Search strategies were: (“bronchiolitis”[MeSH Terms] OR “bronchiolitis”[All Fields]) AND ((“epinephrine”[MeSH Terms] OR “epinephrine”[All Fields]) OR (“dexamethasone”[MeSH Terms] OR “dexamethasone”[All Fields])). The search was limited to RCTs, English language and infants and yielded 36 publications (Cochrane 0, PubMed 36), of which 3 studies were directly relevant to the question. See table 2.
Viral bronchiolitis is the most common lower respiratory tract infection in infants.1 In the United States, viral bronchiolitis causes more than 130 000 hospitalisations per year in children below 5 years of …