From the Guidelines
Prednisolone should not be used routinely in the treatment of bronchiolitis. The current recommendation against the routine use of corticosteroid medications like prednisolone in bronchiolitis management is based on evidence from studies such as the one published in Pediatrics in 2006 1. This guideline emphasizes that corticosteroids should not be part of the standard treatment approach for bronchiolitis.
Key Points to Consider:
- Bronchiolitis is primarily a viral infection, with the respiratory syncytial virus (RSV) being the most common cause.
- The inflammation in bronchiolitis is mediated by pathways that do not respond well to corticosteroids, unlike conditions such as asthma or croup.
- Treatment should focus on supportive care, including:
- Adequate hydration
- Nasal suctioning
- Oxygen supplementation when needed
- In specific cases with underlying conditions or diagnostic uncertainty, a trial of corticosteroids might be considered, but this is not a standard practice for typical bronchiolitis cases.
The use of prednisolone or any corticosteroid in bronchiolitis should be approached with caution and typically reserved for cases where there is a clear benefit, such as in patients with underlying asthma or when the diagnosis is uncertain and other conditions that might benefit from corticosteroids are being considered. However, for the routine treatment of bronchiolitis, the evidence supports a focus on supportive care rather than corticosteroid therapy 1.
From the Research
Role of Prednisolone in Bronchiolitis
- The efficacy of prednisolone in treating bronchiolitis has been studied in various research papers 2, 3, 4, 5, 6.
- A study published in 2019 found that oral prednisolone was effective in reducing respiratory distress and hospital stay in bronchiolitis patients with a family history of atopy, but not in those without such history 2.
- Another study from 2003 found that prednisolone had no significant effect on reducing the prevalence of post-bronchiolitis wheezing and improving the acute course of illness in hospitalized infants with bronchiolitis 4.
- A 2000 study also found that oral prednisolone during the acute phase of RSV bronchiolitis was not effective in preventing post-bronchiolitis wheezing or asthma at the mean age of 5 years 5.
- Similarly, a 1998 study concluded that a 3-day course of oral corticosteroids was of no benefit to infants with mild to moderate bronchiolitis who were also treated with an inhaled beta2-agonist 6.
Key Findings
- Prednisolone may be effective in reducing respiratory distress and hospital stay in bronchiolitis patients with a family history of atopy 2.
- However, prednisolone has been found to have no significant effect on reducing the prevalence of post-bronchiolitis wheezing and improving the acute course of illness in hospitalized infants with bronchiolitis 4, 5, 6.
- The use of prednisolone in bronchiolitis treatment is still a topic of debate, with some studies suggesting its potential benefits in specific patient populations, while others find no significant benefits 2, 3, 4, 5, 6.