Prednisolone Should Not Be Used Routinely for Pediatric Bronchitis
Corticosteroids, including prednisolone, should not be used routinely in the management of bronchiolitis in pediatric patients. 1
Understanding Bronchiolitis in Children
Bronchiolitis is a clinical diagnosis in infants less than 2 years of age that does not require diagnostic testing. It is characterized by:
- First episode of wheezing associated with respiratory symptoms such as rhinitis, tachypnea, and increased respiratory effort 1
- Typically occurs during winter months in previously healthy infants 2
- Risk factors for severe disease include age less than 12 weeks, history of prematurity, underlying cardiopulmonary disease, or immunodeficiency 1
Evidence Against Routine Prednisolone Use
Current guidelines strongly recommend against the routine use of corticosteroids in bronchiolitis management:
- Systematic reviews and meta-analyses involving nearly 1200 children have not shown sufficient evidence to support steroid use in bronchiolitis 1
- Multiple randomized controlled trials demonstrate no significant improvement in clinical outcomes with corticosteroid therapy 2, 3, 4
- No significant reduction in length of hospital stay, duration of oxygen therapy, or time to clinical resolution has been observed with prednisolone treatment 3
Long-Term Outcomes
Research has specifically examined whether corticosteroids during acute bronchiolitis might prevent long-term wheezing:
- Follow-up studies show no significant differences between prednisolone and placebo groups in the prevalence of post-bronchiolitis wheezing at 1,3,6, and 12 months after hospital discharge 3
- Long-term follow-up at age 5 found no significant differences in transient wheezing, persistent wheezing, or late-onset wheezing between children who received prednisolone during acute bronchiolitis and those who received placebo 4
Recommended Management Approach for Bronchiolitis
Instead of corticosteroids, the following approach is recommended:
- Focus on supportive care and monitoring 1
- Assess hydration and ability to take fluids orally (strong recommendation) 1
- Provide supplemental oxygen if SpO2 falls persistently below 90% in previously healthy infants 1
- Discontinue oxygen when SpO2 is at or above 90% and the infant is feeding well with minimal respiratory distress 1
- Avoid routine use of other medications including bronchodilators, antibiotics, and chest physiotherapy 1
Special Considerations
- For children with underlying conditions such as asthma (not bronchiolitis), the National Heart, Lung, and Blood Institute recommends systemic prednisolone at 1-2 mg/kg/day for acute exacerbations 5
- If a child has asthma rather than bronchiolitis, "burst therapy" should be continued until the child achieves a peak expiratory flow rate of 80% of personal best or symptoms resolve (typically 3-10 days) 5
- There is no evidence that tapering the dose after improvement will prevent relapse in asthma exacerbations 5
Prevention of Bronchiolitis
- Hand decontamination is the most important step in preventing spread of respiratory syncytial virus (RSV) 1
- Infants should not be exposed to passive smoking (strong recommendation) 1
- Breastfeeding is recommended to decrease a child's risk of having lower respiratory tract disease 1
- Palivizumab prophylaxis may be considered for infants with history of prematurity or congenital heart disease 1
In conclusion, despite the common practice of prescribing corticosteroids for bronchiolitis, the evidence clearly shows that prednisolone should not be routinely used in the management of pediatric bronchiolitis, as it does not improve short-term clinical outcomes or prevent long-term wheezing.