Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1997 Jul;52(7):634–637. doi: 10.1136/thx.52.7.634

Randomised double blind placebo controlled trial of prednisolone in children admitted to hospital with respiratory syncytial virus bronchiolitis

J B van Woensel, T F Wolfs, W M van Aalderen, P L Brand, J L Kimpen
PMCID: PMC1758598  PMID: 9246136

Abstract

BACKGROUND: Experimental and clinical evidence suggests that respiratory syncytial virus (RSV) bronchiolitis is an immune mediated disease. Corticosteroids might therefore be effective in the treatment of RSV bronchiolitis. METHODS: A randomised double blind trial was conducted in children up to two years of age admitted to hospital with RSV bronchiolitis to compare prednisolone (1 mg/ kg/day orally for seven days) with placebo. Variables used for the efficacy analysis were a daily symptom score and the length of time in hospital in the non- ventilated patients, and the duration of mechanical ventilation and the length of time in hospital in the ventilated patients. RESULTS: Fifty four patients were included in the trial, 40 of whom were non- ventilated (20 in each group) and 14 were ventilated (seven in each group). During the first three days of treatment the symptom score decreased significantly faster in the prednisolone group than in the placebo group (mean (SE) decrease -1.2 (0.2) points/day versus -0.6 (0.2) points/day; mean (95% confidence interval (CI)) for difference = - 0.6 (-0.1 to -1.2); p = 0.02). The mean duration of hospital stay of all 40 non-ventilated patients was not significantly different between the two groups. In the ventilated patients the duration of mechanical ventilation was not significantly different, but the length of time in hospital was six days shorter in the prednisolone group than in the placebo group (mean (SE) 11.0 (0.7) versus 17.0 (2.0) days; mean (95% CI) difference = 7.0 (1.8 to 10.2) days; p < 0.01). CONCLUSIONS: These results suggest that prednisolone may be effective in accelerating the clinical recovery of children admitted to hospital with RSV bronchiolitis. 




Full Text

The Full Text of this article is available as a PDF (111.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Dabbous I. A., Tkachyk J. S., Stamm S. J. A double blind study on the effects of corticosteroids in the treatment of bronchiolitis. Pediatrics. 1966 Mar;37(3):477–484. [PubMed] [Google Scholar]
  2. Garofalo R., Kimpen J. L., Welliver R. C., Ogra P. L. Eosinophil degranulation in the respiratory tract during naturally acquired respiratory syncytial virus infection. J Pediatr. 1992 Jan;120(1):28–32. doi: 10.1016/s0022-3476(05)80592-x. [DOI] [PubMed] [Google Scholar]
  3. Glezen P., Denny F. W. Epidemiology of acute lower respiratory disease in children. N Engl J Med. 1973 Mar 8;288(10):498–505. doi: 10.1056/NEJM197303082881005. [DOI] [PubMed] [Google Scholar]
  4. Graham B. S., Bunton L. A., Wright P. F., Karzon D. T. Role of T lymphocyte subsets in the pathogenesis of primary infection and rechallenge with respiratory syncytial virus in mice. J Clin Invest. 1991 Sep;88(3):1026–1033. doi: 10.1172/JCI115362. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hall C. B., Powell K. R., MacDonald N. E., Gala C. L., Menegus M. E., Suffin S. C., Cohen H. J. Respiratory syncytial viral infection in children with compromised immune function. N Engl J Med. 1986 Jul 10;315(2):77–81. doi: 10.1056/NEJM198607103150201. [DOI] [PubMed] [Google Scholar]
  6. Leer J. A., Jr, Green J. L., Heimlich E. M., Hyde J. S., Moffet H. L., Young G. A., Barron B. A. Corticosteroid treatment in bronchiolitis. A controlled, collaborative study in 297 infants and children. Am J Dis Child. 1969 May;117(5):495–503. [PubMed] [Google Scholar]
  7. Matthews J. N., Altman D. G., Campbell M. J., Royston P. Analysis of serial measurements in medical research. BMJ. 1990 Jan 27;300(6719):230–235. doi: 10.1136/bmj.300.6719.230. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Midulla F., Villani A., Panuska J. R., Dab I., Kolls J. K., Merolla R., Ronchetti R. Respiratory syncytial virus lung infection in infants: immunoregulatory role of infected alveolar macrophages. J Infect Dis. 1993 Dec;168(6):1515–1519. doi: 10.1093/infdis/168.6.1515. [DOI] [PubMed] [Google Scholar]
  9. Ruuskanen O., Ogra P. L. Respiratory syncytial virus. Curr Probl Pediatr. 1993 Feb;23(2):50–79. doi: 10.1016/0045-9380(93)90003-U. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Scarfone R. J., Fuchs S. M., Nager A. L., Shane S. A. Controlled trial of oral prednisone in the emergency department treatment of children with acute asthma. Pediatrics. 1993 Oct;92(4):513–518. [PubMed] [Google Scholar]
  11. Schleimer R. P. Effects of glucocorticosteroids on inflammatory cells relevant to their therapeutic applications in asthma. Am Rev Respir Dis. 1990 Feb;141(2 Pt 2):S59–S69. [PubMed] [Google Scholar]
  12. Sigurs N., Bjarnason R., Sigurbergsson F., Kjellman B., Björkstén B. Asthma and immunoglobulin E antibodies after respiratory syncytial virus bronchiolitis: a prospective cohort study with matched controls. Pediatrics. 1995 Apr;95(4):500–505. [PubMed] [Google Scholar]
  13. Springer C., Bar-Yishay E., Uwayyed K., Avital A., Vilozni D., Godfrey S. Corticosteroids do not affect the clinical or physiological status of infants with bronchiolitis. Pediatr Pulmonol. 1990;9(3):181–185. doi: 10.1002/ppul.1950090311. [DOI] [PubMed] [Google Scholar]
  14. Welliver R. C., Kaul T. N., Ogra P. L. The appearance of cell-bound IgE in respiratory-tract epithelium after respiratory-syncytial-virus infection. N Engl J Med. 1980 Nov 20;303(21):1198–1202. doi: 10.1056/NEJM198011203032103. [DOI] [PubMed] [Google Scholar]
  15. Wong D. T., Rosenband M., Hovey K., Ogra P. L. Respiratory syncytial virus infection in immunosuppressed animals: implications in human infection. J Med Virol. 1985 Dec;17(4):359–370. doi: 10.1002/jmv.1890170408. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES