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JAMA Clinical Evidence Synopsis |

Glucocorticoids for Acute Viral Bronchiolitis in Infants and Young Children

Ricardo M. Fernandes, MD1,2; Lisa Hartling, PhD3
[+] Author Affiliations
1Department of Pediatrics, Santa Maria Hospital, Lisbon Academic Medical Centre, Portugal
2Clinical Pharmacology Unit, Instituto de Medicina Molecular, University of Lisbon, Portugal
3Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Canada
JAMA. 2014;311(1):87-88. doi:10.1001/jama.2013.284921.
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Clinical Question  Are glucocorticoids, alone or combined with bronchodilators, associated with reduced admission rates, length of stay, or improvements in clinical severity scores without increased adverse effects in infants and young children with acute viral bronchiolitis?

Bottom Line  There is no consistent clinically relevant association of single therapy with systemic or inhaled glucocorticoids and improved outcomes in either outpatient or inpatient settings. Exploratory evidence suggests that combined glucocorticoids and nebulized epinephrine may be associated with lower hospitalization rates in outpatients, but these findings must be interpreted cautiously.

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Figure.
Hospitalizations in Outpatients (Days 1 and 7) for Glucocorticoids vs Placebo

Source: Data have been adapted with permission from the Cochrane Collaboration.5 The relative risk was calculated using the Mantel-Haenszel random effect method. Kuyucu and Plint (both factorial trials) and Barlas (parallel multi-group trial) contribute 2 independent comparisons, which are shown separately. The size of the data markers indicate the weight assigned to each study in the meta-analysis. G indicates glucocorticoid; S, salbutamol; E, epinephrine; P, placebo.

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