Acute bronchiolitis in Switzerland – Current management and comparison over the last two decades

Abstract

Background Although international guidelines and Cochrane reviews emphasize that therapies do not alter the natural course of acute viral bronchiolitis (AVB), they are still prescribed frequently. This survey evaluated self‐reported management of AVB by Swiss pediatricians in 2019 and compared it with previous surveys. Methods We performed a cross‐sectional online survey of all board‐certified pediatricians in Switzerland in November 2019 and compared the reported use of therapies with that reported in the 2001 and 2006 surveys. We used multivariable ordered logistic regression to assess factors associated with reported prescription of bronchodilators, corticosteroids, antibiotics, and physiotherapy. Results Among 1618 contacted board‐certified pediatricians, 884 returned the questionnaires (55% response rate). After exclusions were applied, 679 were included in the final analysis. Pediatricians working in primary care reported using therapeutics more frequently than those working in a hospital setting, either always or sometimes: bronchodilators 53% versus 38%, corticosteroids 37% versus 23%, and antibiotics 39% versus 22%. The opposite occurred with physiotherapy: 53% reported prescribing it in hospital and 44% in primary care. There was an overall decrease in the prescription of therapeutics and interventions for AVB from 2001 to 2019. The proportion who reported “always” prescribing corticosteroids decreased from 71% to 2% in primary care, and of those “always” prescribing bronchodilators from 55% to 1% in hospitals. Conclusion Although we observed a significant decrease since 2001, more effort is required to reduce the use of unnecessary therapies in children with AVB.

Factors associated with nonadherence to the American Academy of Pediatrics 2014 bronchiolitis guidelines: A retrospective study

“…Our results are, overall, in line with previous reports [ 8 – 11 ]. The strength of our study lies first, in that we were able to retrieve robust data from patients presenting with acute bronchiolitis between three distinct periods of observation.…”

3% nebulized hypertonic saline versus normal saline for infants with acute bronchiolitis: A systematic review and meta-analysis of randomized controlled trials

“…All 27 trials had random sequence generation and provided adequate information on incomplete outcomes, selective reporting, and other bias. [21–47] Twenty studies reported sufficient information on allocation concealment, [3–32,36,38–45,47] and 18 RCTs elaborated the blinding of participants and personnel clearly. [21–23,25–28,30–32,36,39–45,47] All trials described blinding of outcome assessments, except for 10 studies, [24,28,29,33–35,37,38,40,46] which provided insufficient information.…”

“…Presently, management of AB mainly consists of supportive care, supplemental oxygen, adequate hydration, mechanical ventilatory support, antibiotics, corticosteroids, chest physiotherapy, magnesium sulfate, and nebulized hypertonic saline (NHS). [11–21] Previous studies have reported that NHS can benefit infants with AB. [21–47] It has been reported that NHS can induce osmotic flow of water into the lung mucosa, rehydrate airway surface lipid, increase mucosa cilia function, and enhance airway obstruction by clearing sputum outside of the bronchi.…”

Design and reliability study of a parental knowledge, attitude, and practice questionnaire on prevention and management of acute bronchiolitis of children under two years of age

“…Sin embargo, no existe ninguna herramienta similar al cuestionario aquí presentado que permita evaluar si los conocimientos de los padres son los correctos y si sus prácticas se corresponden con lo que recomienda la literatura para esta patología. Además, hay que destacar que entre los propios pediatras existen discrepancias entre las guías clínicas y el abordaje que se realiza en la bronquiolitis, lo cual también puede influir en la educación sanitaria que se da a los cuidadores 28 .…”