Systemic steroid treatment of acute bronchiolitis: A retrospective study

Hyo Rim Suh; Ji Young Ahn; Bong Seok Choi

doi:10.4168/aard.2017.5.6.326

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

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

Original Article

Allergy, Asthma & Respiratory Disease 2017; 5(6): 326-330.

Published online: 30 November 2017

DOI: https://doi.org/10.4168/aard.2017.5.6.326

Systemic steroid treatment of acute bronchiolitis: A retrospective study

Hyo Rim Suh, Ji Young Ahn, Bong Seok Choi

Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea.

Correspondence to: Bong Seok Choi. Department of Pediatrics, Kyungpook National University School of Medicine, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-200-5704, Fax: +82-53-425-6683, bschoi@knu.ac.kr

Received 19 April 2017 Revised 13 July 2017 Accepted 19 July 2017

The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

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.

Keywords: Bronchiolitis, Steroid, Child

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.

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.

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.

Table 1

Characteristics of the subjects

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