Corticosteroids are ineffective against obstructive bronchitis

Author Prof. J. Spranger, University Department of Pediatrics Mainz

To test the efficacy of corticosteroids, 195 infants with acute obstructive bronchitis received a daily dose of 2 mg/kg oral prednisolone for 3 days, while the 198 infants of the control group received a placebo [1]. Age, sex, initial disease severity and other variables were randomised. Disease progression was assessed using the PRAM-score, i.e. a validated scoring tool with scaled observational values for suprasternal retraction, scalene muscle contraction, wheezing, air entry and oxygen saturation. The basic treatment including the use of salbutamol inhalers was identical in both groups. 4 and 24 hours after the start of treatment, the scores had equally improved in both groups. Secondary outcomes such as the duration of hospitalisation or time in intensive care did not suggest any benefits of adding corticosteroids to the standard treatment either.

Comment: The study differs from previous analyses in using a validated scoring tool for clinical symptomatology. It shows once more that corticosteroids are of no use in the treatment of spastic bronchitis, and only carry the risk of adverse events following oral corticosteroid bursts [2].

[1] Wallace A, Sinclair O, Shepherd M, et al. Impact of oral corticosteroids on respiratory outcomes in acute preschool wheeze: a randomised clinical trial. Archives of Disease in Childhood. 2021;106(4):339-344.
[2] Yao TC, Wang JY, Chang SM, et al. Association of oral corticosteroid bursts with severe adverse events in children. JAMA pediatrics. 2021;175(7):723-729.