Adrenaline and Dexamethasone, vs Adrenaline and Fluticasone, vs Adrenaline alone in Bronchiolitis: A Randomized Controlled Trial

Main Article Content

Jayendra R Gohil
Atul M. Sheladiya
N. B. Adithya
Ratna D. Bhojak

Abstract

Background and Objectives: There is no consensus over which drug best reduces symptoms in Bronchiolitis syndrome. The primary objective of our study is to establish comparative effect of adrenaline nebulisation alone and combination of adrenaline nebulisation plus injectable dexamethasone and adrenaline nebulisation plus fluticasone nebulisation in the treatment of clinical cases of bronchiolitis.

Methods: 100 patients diagnosed clinically as bronchiolitis were enrolled in study from 1 month to 24 months of age. Patients were enrolled by purposive sampling. Patients with respiratory distress assessment instrument score [RDAI] of 4 to 15 were chosen, randomized into three groups and treatment given till patient fullfilled discharge criteria. Group A (n=33) were given nebulised adrenaline alone, Group B (n=34) were given nebulised adrenaline plus injectable dexamethasone and Group C (n=33) were given nebulised adrenaline plus nebulised fluticasone.

Results: The mean reduction in clinical severity-RDAI score was 1.75 ±0.86 in Group A, 2.30 ± 0.68 in Group B and 1.42 ± 0.9 in Group C when measured in terms of difference in clinical scores between day 1 and 2 (p=0.0003).

Mean duration of hospital stay in the group A was (4.93±1.95 days), Group C (4.78±1.83) and Group B (3.91 ±1.37 days). The difference of stay between the Groups A and B was 1.02±0.58 days vs 0.87± 0.46 days in groups B and C (p-0.0048). Reduction in the length of hospital stay in group B was 22% compared to Group A & 19% compared to Group C (p-0.0048).

Side effects were tachycardia in six patients.

Conclusion: Combination of adrenaline nebulization and injectable dexamethasone was found significantly better as compared to nebulised adrenaline plus nebulised fluticasone and nebulised adrenaline alone in patients of clinical bronchiolitis in reducing severity of clinical symptoms and duration of hospitalization.

Keywords:
Bronchiolitis, adrenaline, dexamethasone, fluticasone, nebulisation.

Article Details

How to Cite
Gohil, J. R., Sheladiya, A. M., Adithya, N. B., & Bhojak, R. D. (2020). Adrenaline and Dexamethasone, vs Adrenaline and Fluticasone, vs Adrenaline alone in Bronchiolitis: A Randomized Controlled Trial. Asian Journal of Pediatric Research, 3(1), 20-28. https://doi.org/10.9734/ajpr/2020/v3i130120
Section
Original Research Article

References

Price JF. Acute and long-term effects of viral bronchiolitis in infancy. Lung. 1990;168(Suppl):414–21.

American academy of pediatrics subcommittee on diagnosis and management of bronchiolitis. Pediatrics. 2006;118:1774-93.

King VJ, Viswanathan M, Bordley WC, Jackman AM, Sutton SF, Lohr KN, et al. Pharmacologic treatment of bronchiolitis in infants and children: A systematic review. Arch Pediatr Adolesc Med. 2004;158:127-37.

Kellner JD, Ohlsson A, Gadomski AM, Wang EE. Efficacy of bronchodilator therapy in bronchiolitis. A meta-analysis. Arch Pediatr Adolesc Med. 1996;150:1166-72.

Flores G, Horwitz RI. Efficacy of beta2-agonists in bronchiolitis: A reappraisal and meta-analysis. Pediatrics 1997;100:233-9.

Hartling L, Wiebe N, Russell K, Patel H, Klassen TP. A meta-analysis of RCT evaluating the efficacy of epinephrine for treatment of acute viral bronchiolitis. Arch Pediatr Adolesc Med. 2003;157:957-64.

Plint AC, Johnson DW, Patel H, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med. 2009;360:2079–89.

Kuyucu S, Unal S, Kuyucu N, et al. Additive effects of dexamethasone in nebulised salbutamol or L-epinephrine treated infants with acute bronchiolitis. Pediatr Int. 2004;46:539–44.

Bentur L, Shoseyov D, Feigenbaum D, et al. Dexamethasone inhalations in RSV bronchiolitis: A double-blind, placebo-controlled study. Acta Paediatr. 2005;94: 866–71.

Lowell DI, Lister G, Von Kloss H, McCarthy P. Wheezing in infants: The response to epinephrine. Pediatrics. 1987;79(6):939–45.
PMID: 3295741

Liza Bialy, Foisy M, Smith M, Fernandes RM. Evidence-based child health: A cochrane review. Journal Evid. Based Child Health. 2011;6:258–275.
DOI: 10.1002/ebch.673

Carvalho WBD, Johnston C, Fonseca MCM. Bronchiolitis and Roger’s Textbook of Intensive Care. 4th Ed. Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins. 2008;716-721.

Law BJ, Langley JM, Allen U, Paes B, Lee D, Mitchell I, et al. Pediatric investigators collaborative network on infections in Canada study of predictors of hospitalization for RSV infection for infants born at 33 through 35 completed weeks of gestation. Pediatr Infect Dis J. 2004;23: 806–814.

Roosevelt G, Sheehan K, Grupp Phelan J, Tanz RR, Listernick R. Dexamethasone in bronchiolitis: A randomised controlled trial. Lancet. 1996;348:292-5.

Klassen TP, Sutcliffe T, Watters LK, Wells GA, Allen UD, Li MM. Dexamethasone in salbutamol treated in patients with acute bronchiolitis: A randomized, controlled trial. J Pediatr. 1997;130:191-6.

Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev. 2010;CD004878.

Schuh S, Coates AL, Binnie R, Allin T, Goia C, Corey M, et al. Efficacy of oral dexamethasone in outpatients with acute bronchiolitis. J Pediatr. 2002;140:27-32.

Teeratakulpisarn J, Limwattananon C, Tanupattarachai S, et al. Efficacy of dexamethasone injection for acute bronchiolitis in hospitalized children: A RCT. Pediatric Pulmonology. 2007;42(5): 433-439.
DOI: 10.1002/ppul.20585

Fernandes RM, Wingert A, Vandermeer B, Featherstone R, Ali S, Plint AC, Stang AS, Rowe BH, Johnson DW, Allain D, Klassen TP. Safety of corticosteroids in young children with acute respiratory conditions: A systematic review and meta-analysis. BMJ Open. 2019;9(8):e028511.