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document
Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis : a randomized , controlled trial . OBJECTIVE To determine the clinical benefit of oral dexamethasone in children admitted to the hospital with bronchiolitis treated with nebulized salbutamol . METHODS Randomized , double-blind , placebo-controlled trial in the inpatient wards of a pediatric tertiary care hospital . The participants , children aged 6 weeks to 15 months , admitted with first-time wheezing , were eligible if their oxygen saturation was less than 95 % on admission to the hospital and their Respiratory Distress Assessment Instrument ( RDAI ) score was greater than 6 . Patients were excluded if they had any one of the following : an underlying disease that might affect cardiopulmonary status , asthma , recent treatment with steroids ( within 2 weeks ) , or any history of adverse reaction to steroids . Patients were randomly assigned to receive either orally administered dexamethasone with 0.5 mg/kg as the first dose and 0.3 mg/kg for the next 2 mornings , or an equal volume of an orally administered placebo with an identical appearance . All patients received nebulized salbutamol at 0.15 mg/kg every 4 hours for the first 24 hours . The primary outcome measure was the change from baseline in the RDAI score at 24 hours . Secondary outcome measures were oxygen saturation , respiratory rate , RDAI measurement twice daily for the first 4 days , and the length of hospitalization . RESULTS At 24 hours the mean change ( SD ) from baseline in the RDAI score was 1.6 ( 2.3 ) in the placebo group ( n = 28 ) and 1.4 ( 2.0 ) in the dexamethasone group ( n = 33 ; p = 0.74 ) . There were no significant differences between the two groups in change in oxygen saturation , respiratory rate , and RDAI score at any assessment period . The median length of stay ( 95 % confidence interval ) for the placebo group was 48 ( 42 , 54 ) hours compared with 57 ( 38 , 76 ) hours in the dexamethasone group ( p = 0.19 ) . CONCLUSIONS Oral dexamethasone therapy does not affect the clinical course of children hospitalized with bronchiolitis and therefore can not be recommended in this clinical situation .
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Intervention_Pharmacological
Dexamethasone
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Intervention_Pharmacological
dexamethasone with 0.5 mg/kg
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Intervention_Control
placebo
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Intervention_Pharmacological
salbutamol
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Outcome_Other
clinical benefit
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Outcome_Physical
Respiratory Distress Assessment Instrument ( RDAI ) score
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Outcome_Physical
RDAI score
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Outcome_Physical
oxygen saturation
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Outcome_Physical
respiratory rate
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Outcome_Physical
RDAI measurement twice daily
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Outcome_Other
length of hospitalization
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Outcome_Other
mean change ( SD )
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Outcome_Physical
RDAI score
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Outcome_Physical
oxygen saturation
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Outcome_Physical
respiratory rate
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Outcome_Physical
RDAI score
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Outcome_Other
median length of stay
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Participant_Condition
salbutamol-treated inpatients with acute bronchiolitis :