Journal List > Allergy Asthma Respir Dis > v.5(6) > 1059284

Suh, Ahn, and Choi: Systemic steroid treatment of acute bronchiolitis: A retrospective study

Abstract

Purpose

Previous studies have reported that clinical efficacy of steroid therapy for acute bronchiolitis is controversial. However, since it is still frequently used in clinical practice, we sought to re-evaluate its effectiveness.

Methods

This study included 277 children with acute bronchiolitis who were admitted to Kyungpook National University Children's Hospital from March 2013 to July 2016. Erythrocyte sedimentation rates, C-reactive protein (CRP) levels, and viral polymerase chain reaction testing results were obtained, and respiratory rate (RR) was measured periodically. Forty-eight patients were treated with an intravenous (IV) steroid (17.3%, IV group) and 19 patients were treated with a per oral (PO) steroid medication (6.9%, PO group). The remaining 210 patients were steroid-free patients (74.2%, nonsteroid group).

Results

RR and CRP levels were higher in the IV group, along with a longer hospitalization period and duration of wheezing. The rate of change from the fastest initial RR to the mean RR on the first treatment day was greatest in the IV group; this finding was statistically significant after controlling for initial RR (16.06% in the IV group, 3.94% in the PO group, 4.90% in the nonsteroid group; P<0.01).

Conclusion

There was a trend of IV steroid treatment toward more severe bronchiolitis. A significant reduction in RR on the first day of steroid treatment was observed in IV steroid-treated patients. IV steroid therapy may play a positive role in initial RR stabilization for severe bronchiolitis.

Figures and Tables

Fig. 1

(A) The mean value of initial CRP in the IV steroid group was higher than PO steroid group. (B) The mean duration of admission in the group of IV steroid was longer than other 2 groups. (C) The mean time of wheezing resolution after admission in IV steroid group was longer than other 2 groups. (D) The mean of initial respiratory rate in the first day of therapy in IV steroid group was faster than other 2 groups. CRP, C-reactive protein; IV, intravenous; PO, per oral.

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Fig. 2

The result of multiplex real-time polymerase chain reaction (RT-PCR) detection test (n=103) shows respiratory syncytial virus (RSV) is the most common in any group. IV, intravenous; PO, per oral.

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Fig. 3

The rate of change of respiratory rate (RR) between the fastest RR before treatment and the mean RR of first day of treatment was higher in intravenous (IV) steroid group than other 2 groups. PO, per oral.

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Table 1

Characteristics of the subjects

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Characteristic Total IV steroid PO steroid No steroid P-value
No. of subjects 277 (100) 48 (17.3) 19 (6.9) 210 (74.2)
Sex, male:female 179:98 33:15 14:5 132:78 0.52
Age (yr) 0.8 ± 0.7 0.7 ± 0.6 0.7 ± 0.4 0.8 ± 0.8 0.31
Admission duration (day) 3.6 ± 2.5 5.6 ± 2.4 3.2 ± 3.0 3.1 ± 2.2 < 0.001*
Wheezing resolution after admission (day) 2.5 ± 1.7 4.5 ± 2.3 2.3 ± 1.3 2.1 ± 1.3 < 0.001*
Chest retraction 44 (1.5) 20 (41.7) 3 (15.8) 21 (10) < 0.001*
Laboratory findings
 ESR (mm/hr) 12.6 ± 13.3 11.8 ± 9.6 9.1 ± 7.0 13.2 ± 14.5 0.46
 CRP (mg/dL) 1.0 ± 1.6 1.4 ± 1.6 0.5 ± 0.7 1.0 ± 1.6 0.11
 WBC (× 103/µL) 11.3 ± 6.2 11.9 ± 5.3 10.8 ± 4.1 11.2 ± 6.6 0.77
 Neutrophils (%) 39.1 ± 20.0 48.6 ± 21.1 28.1 ± 14.0 37.8 ± 19.3 < 0.001*
 Lymphocytes (%) 48.3 ± 18.6 39.6 ± 18.6 58.1 ± 12.6 49.6 ± 18.4 < 0.001*
 Eosinophils (%) 1.8 ± 1.9 1.8 ± 1.8 1.5 ± 1.3 1.9 ± 1.1 0.74

Values are presented as number (%), number, or mean±standard deviation.

ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; WBC, white blood cell.

*P<0.05, statistically significant.

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Bong Seok Choi
https://orcid.org/0000-0002-2129-7232

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