From the Guidelines
Bronchiolitis is the respiratory disease in children that is not typically treated with steroids (corticosteroids). This common lower respiratory tract infection, most often caused by respiratory syncytial virus (RSV), primarily affects infants and young children under 2 years of age. Despite being characterized by inflammation, wheezing, and respiratory distress that might seem similar to asthma, multiple clinical trials and guidelines consistently recommend against using corticosteroids for bronchiolitis treatment, as stated in the Pediatrics journal in 2006 1. The standard management focuses on supportive care including adequate hydration, nasal suctioning, and oxygen supplementation when needed.
Some key points to consider in the management of bronchiolitis include:
- The lack of benefit from corticosteroids in improving clinical outcomes, reducing hospitalization rates, or shortening the duration of symptoms in bronchiolitis, as highlighted in a Cochrane database review 1.
- The distinct pathophysiology of bronchiolitis, which involves direct viral damage to epithelial cells, mucus production, and edema, rather than the eosinophilic inflammation seen in asthma that responds well to steroids.
- The recommendation against the routine use of corticosteroid medications in the management of bronchiolitis, based on evidence level B and a preponderance of risk over benefit, as stated in the Pediatrics journal in 2006 1.
It's worth noting that while bronchiolitis is not typically treated with steroids, other respiratory conditions such as asthma, croup, or certain pneumonias may benefit from steroid treatment, as discussed in the Journal of Allergy and Clinical Immunology in 2002 1 and 2002 1. However, the focus here remains on bronchiolitis, where the evidence supports a non-steroid approach to management, as also discussed in the Chest journal in 2018 1 and the Pediatrics journal in 2006 1. The most recent and highest quality study, which is from 2006 1, prioritizes the well-being and safety of the children, and thus, steroids are not recommended for bronchiolitis.
From the Research
Respiratory Disease in Children Not Typically Treated with Steroids
- Bronchiolitis is a common respiratory disease in children that is not typically treated with corticosteroids 2, 3.
- The use of corticosteroids in the treatment of bronchiolitis is not justified due to the lack of demonstrated clinical benefits 2.
- Treatment for viral bronchiolitis, including bronchiolitis caused by respiratory syncytial virus (RSV), is mainly symptomatic support, and corticosteroids are generally not effective 3, 4.
- Some studies suggest that inhaled corticosteroids may have a beneficial effect on subsequent bronchial wheezing tendency in children with RSV bronchiolitis 5, but this is not a typical treatment approach.
Controversies and Exceptions
- The appropriate use of corticosteroids in the treatment of RSV bronchiolitis remains controversial, with some meta-analyses showing inconsistent results 4.
- High-risk children, such as those with preterm birth, cardiopulmonary disease, or immunodeficiency, may require hospitalization and supportive therapies, but corticosteroids are not typically used as a treatment 4, 6.