Grant: Planning Grants - Priority Announcement: International Research Collaborations

Bronchiolitis is the most common infection of the lower respiratory tract in infancy. Hospital admissions for bronchiolitis have doubled over the past decade and associated costs are significant. Treatment remains controversial. Bronchodilators and corticosteroids are widely used although not routinely recommended. A large trial by the US based Pediatric Emergency Care Applied Research Network (PECARN) showed no benefit of dexamethasone in treating bronchiolitis. The Canadian network Pediatric Emergency Research Canada (PERC) recently completed a CIHR-funded multicentre RCT of epinephrine and dexamethasone. In this study (known as CanBEST) treatment with epinephrine or dexamethasone alone did not reduce admissions but combined treatment appeared to be effective, reducing admissions by 35% relatively and 9% absolutely. There are several points that need to be considered in exploration of CanBEST results. The first is that epinephrine and dexamethasone synergy without benefit of either drug individually was unexpected and the results might be considered exploratory although animal and clinical evidence supports the observed synergy. Second, steroids have potential, serious side effects and the CanBEST dexamethasone dose was high. Animal and clinical evidence suggest that lower a dose may be effective. Third, many physicians treat with albuterol despite no evidence of benefit. Given the health care burden of bronchiolitis, practice variation, biological plausibility for epinephrine and dexamethasone synergy, and promising clinical results, a large, definitive trial is needed. We propose a PERC-PECARN collaboration to complete a trial in a timely manner. The primary objectives of a CIHR funded meeting would be to strength ties between PERC and PECARN, to review the current evidence in treating bronchiolitis, and to develop a multicentre research proposal examining the role of combined epinephrine and steroids in bronchiolitis treatment.