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Oral steroids are not indicated in bronchiolitis.

Three Part Question

In [infants with bronchiolitis] do [oral steroids] reduce [clinical severity or length of hospital stay].

Clinical Scenario

A 6 month old baby is admitted to hospital with a 4 day history of coryzal symptoms, cough, wheeze and decrease in feeds. Respiratory syncytial virus is detected in nasopharyngeal secretion. She is needing oxygen and is on a nasogastric feed. You wonder whether starting oral steroids will improve her clinical condition.

Search Strategy

Medline 1966-2008
Embase 1980-2008
Cochrane database of systematic reviews and Cochrane central register of controlled trials
(Oral steroids or prednisolone) AND (bronchioloitis or RSV bronchiolitis) limit to human, english and randomised controlled trails

Search Outcome

35 hits, 6 relevant papers.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Zhang L et al
52 patients, aged less than 12 months. Oral prednisolone (1mg/kg/day) for 5 days plus standard care vs. standard careRandomised controlled trialLength of hospital stayNo significant differenceNo microbiological confirmation of diagnosis. Small study.
Duration of oxygen therapyNo significant difference
Time to clinical resolutionNo significant difference
Prevalence of post bronchiolitis wheezingNo significant difference
Corneli HM et al
600 patients aged 2-12 months. Oral dexamethasone (1 mg/kg) 1 dose vs placeboRandomised double-blind placebo-controlled trailHospital admissionNo significant differenceNo microbiological confirmation of diagnosis
Respiratory assessment change scoreNo significant difference
Later medical visitsNo significant difference
Berger I et al.
38 patients (1-18 months). Oral prednisolone (2 mg/kg/d) for 3 days vs placebo. All patients received nebulised salbutamolRandomised double blind placebo controlled trialClinical scoreNo significant differenceMicrobiological confirmation of diagnosis in only 50 % of cases. Inappropriate use of the mean as measure of distributions in small samples. No power calculation regarding chronic symptoms.
Oxygen saturationNo significant difference
Development of chronic respiratory symptoms (at 2 year follow up)No significant difference
Goebel J et al.
48 children (less than 23 months). Oral prednisolone (2mg/kg/d) for 5 days vs placebo. All patients received nebulised salbutamol.Clinical trialBronchiolitis scoreSignificant improvement in prednisolone group by day 2 but no difference later onExclusion of mild and severe cases of bronchiolitis. Selection bias: only patients with wheeze not responding to nebulised salbutamol were included. 54% of cases and 37% of controls without microbiological confirmation of diagnosis.
Length of hospital stayNo significant difference
Klassen TP et al.
67 patients (6 weeks-15 months) Oral dexamethasone(0.5mg/kg/d- day 1, 0.3mg/kg/d- day 2 & 3) vs placeboRandomised double blind placebo controlled trialOxygen saturationNo significant differenceShort duration (3 days) of treatment. Application of mean and t-test to ordinal scale data inappropriate. No microbiological confirmation in 12 % of controls and 14 % of cases. No justification of choice of primary outcome. Treatment given for 2 days beyond time of primary outcome assessment.
Respiratory rateNo significant difference
RDAI scoreNo significant difference
Length of hospital stayNo significant difference
Van Woensel JB et al.
54 patients aged less than 2 years. Oral prednisolone (1mg/kg/d) for 7 days vs placeboRandomised double blind placebo controlled trialSymptom score (non ventilated patients)Significantly faster improvement in prednisolne group (day 3)No power calculation for ventilated patients. Small number of ventilated patients.
Length of hospital stay (non ventilated patients)No significant difference
Duration of mechanical ventilation(ventilated patients)No significant difference
Length of hospital stay (ventilated patients)Significantly less in prednisolone group


The largest of the studies (Corneli et al) was conducted in the Emergency Department. Neither the primary outcome measure (hospital admission) nor the secondary outcomes (length of hospital stay and clinical score) showed any significant improvement with steroids. In the first 2 days of treatment prednisolone seems to accelerate the improvement of clinical scores transiently without impact on overall outcomes, such as, duration of hospitalisation or chronic symptoms.

Clinical Bottom Line

Current evidence does not support bronchiolitis as an indication for oral steroids.


  1. Zhang L, Ferruzzi E, Bonfanti T, Auler MI, D'Avila NE, Faria CS, Costa MM Long and short-term effect of prednisolone in hospitalized infants with acute bronchiolitis J Paediatr Child Health 2003; 39(7):548-51
  2. Corneli HM, Zorc JJ, Majahan P, Shaw KN, Holubkov R, Reeves SD et al of the Bronchiolitis Study Group of the Pediatric Emergency Care Applied Reserach Network (PECARN) A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis New England Journal of Medicine 2007; 357(4):331-9
  3. Berger I, Argaman Z, Schwartz SB, Segal E, Kiderman A, Branski D, Kerem E . Efficacy of corticosteroids in acute bronchiolitis: Short term and long term follow up. Pediatric Pulmonology 1998;26(3):162-166.
  4. Goebel J, Estrada B, Quinonez J, Nagji N, Sanford D, Boerth RC. Prednisolone plus albuterol versus albuterol alone in mild to moderate bronchiolitis. Clinical Pediatrics 2000;39(4):213-220.
  5. Klassen TP, Sutcliffe T, Watters LK, Wells GA, Allen UD, Li MM. Dexamethasone in salbutamol- treated inpatients with acute bronchiolitis: a randomised controlled trial. The Journal of Pediatrics 1997;130(2):191-196.
  6. van Woensel JB, Wolfs TF, van Aalderen WM, Brand PL, Kimpen JL. Randomised double blind placebo controlled trial of prednisolone in children admitted to hospital with respiratory syncytial virus bronchiolitis. Thorax 1997;52(7):634-637.