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Combo Treatment Eases Wheezing in Babies
Date:5/13/2009

Epinephrine, dexamethasone reduces hospitalization risk by 35%, study finds

WEDNESDAY, May 13 (HealthDay News) -- A combination of commonly used medications may ease the symptoms of bronchiolitis -- a virus-triggered condition that causes wheezing in babies.

New research suggests this treatment may reduce the risk of hospitalization by more than one-third, as well as stop wheezing sooner and get babies back to normal feeding sooner than either treatment alone or a placebo.

"Until this point, we've had no good treatment options for bronchiolitis, except for supplemental oxygen and extra fluids. In this study, we looked at two medications that have been used to treat bronchiolitis without great benefit when used separately. But, combining the two resulted in a reduction of hospitalizations," said study author Dr. Amy Plint, a pediatric emergency physician at Children's Hospital of Eastern Ontario in Ottawa, Canada.

Results of the study appear in the May 14 issue of the New England Journal of Medicine.

Bronchiolitis is a common illness in very young children. About one in three youngsters in Western countries will have at least one episode of wheezing before turning 3, according to information in an editorial in the same issue of the journal. Most of this wheezing, the editorial authors pointed out, isn't the result of asthma. Instead, it is triggered by a virus.

Plint and her colleagues included 800 infants with bronchiolitis who were between the ages of 6 weeks and 12 months. The babies were randomly assigned to one of four groups: The first group was given two treatments of nebulized epinephrine and six oral doses of the corticosteroid dexamethasone for five days; the second received nebulized epinephrine and an oral placebo; the third group received a nebulized placebo and the oral dexamethasone; and the final group was given a nebulized and oral placebo treatment.

After seven days, 17.1 percent of babies in the double-treatment group had to be hospitalized. In comparison, 23.7 percent in the epinephrine-only group had to be admitted, 25.6 percent in the dexamethasone group were hospitalized, and 26.4 percent in the placebo group were admitted to the hospital.

The group that received the combination treatment also needed less medical care, stopped wheezing sooner, and returned to normal feeding sooner than babies in the other groups.

"I think we now have good evidence of a combined treatment that appears to have benefits in reducing hospitalizations and proving treatment benefits," said Plint.

Not everyone agrees, however.

The editorial authors wrote that, "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."

However, Plint said the treatment was well-tolerated, and there's no evidence in this age group that there are any neurodevelopmental effects from a short course of steroids. And, she pointed out, steroids are often given to help the lungs mature in premature infants.

"Parents should understand when looking at different treatment modalities, a combination of medications may be more effective than either one alone. But, more studies need to be done," said Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital in Detroit.

Appleyard said she is concerned, however, that if this combination becomes the treatment of choice in the emergency room that children who make multiple visits over the course of a viral season might end up getting repeated high doses of steroids.

Plint said that this combination treatment should only be used for a child's first episode of wheezing.

More information

To read more about bronchiolitis, visit the U.S. National Library of Medicine.



SOURCES: Amy Plint, M.D., pediatric emergency physician, Children's Hospital of Eastern Ontario, and associate professor, pediatrics and emergency medicine, University of Ottawa, Canada; Jennifer Appleyard, M.D., chief, allergy and immunology, St. John Hospital, Detroit; May 14, 2009, New England Journal of Medicine


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