Bronchodilators for bronchiolitis

Gadomski, Anne; Brower, Melissa

doi:10.1002/14651858.cd001266.pub3

Cited by 98 publications

(101 citation statements)

References 77 publications

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“…Considering only respiratory distress scores, 64% of infants benefited from bronchodilators, but the improvement in scores, although statistically significant, was small and judged to be not clinically significant. 6 It is critical to note, however, that these studies compared nebulized bronchodilator coadministered with 0.9% normal saline and "placebo" containing only nebulized normal saline. In a reappraisal of an earlier Cochrane Review of this topic, it was noted that inhalation with normal saline alone successfully reduced respiratory distress scores in 43% of infants in the control arms.…”

Section: But If It's Asthma Then Why Don't Asthma Medications Work?mentioning

confidence: 99%

Maybe there is no such thing as bronchiolitis

Kuzik

2016

CMAJ

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Section: But If It's Asthma Then Why Don't Asthma Medications Work?mentioning

confidence: 99%

Maybe there is no such thing as bronchiolitis

Kuzik

2016

CMAJ

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“…Because bronchiolitis clinically resembles asthma, b-agonists are the most commonly overused, nonevidencebased therapy. 3,10,12 The negative consequences of b-agonist usage in bronchiolitis are unnecessary costs and adverse effects (primarily tachycardia, irritability, and muscle tremors).…”

Section: Primary Outcomementioning

confidence: 99%

“…Although respiratory scores have not been convincingly validated for predictive utility in the research setting, improvement in a respiratory score has no clinical significance in terms of risk of hospitalization, length of stay or other studied outcomes. 44,45 Nevertheless, the literature we reviewed consistently shows that absence of improvement in a score can be used as a QI tool to "weed out" unnecessary bronchodilator use without compromising outcomes. Scores work to decrease bronchodilator usage, either because they actually tell us something about the patient or because they do something to the psychology of the bedside caregiver.…”

Section: Figurementioning

confidence: 99%

“…Unfortunately, despite the high volume and significant economic impact of the disease, clinical trials have failed to establish any specific therapy as effective; therefore, supportive care is the mainstay of an evidencebased approach to the disease. [3][4][5][6][7] Nevertheless, overuse of ineffective therapy remains common in bronchiolitis, with overuse of b-agonists, corticosteroids, antibiotics, viral testing, and chest radiography all well documented. [8][9][10][11] In response to the problem, many hospitals have adopted quality improvement (QI) strategies, such as implementing clinical practice guidelines, intended to standardize the approach to bronchiolitis or to operationalize recommendations made in national evidence-based guidelines.…”

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confidence: 99%

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Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

et al. 2014

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BACKGROUND: Bronchiolitis causes nearly 20% of all acute care hospitalizations for young children in the United States. Unnecessary testing and medication for infants with bronchiolitis contribute to cost without improving outcomes. OBJECTIVES:The goal of this study was to systematically review the quality improvement (QI) literature on inpatient bronchiolitis and to propose benchmarks for reducing unnecessary care. METHODS:Assisted by a medical librarian, we searched Medline, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. Studies describing any active QI intervention versus usual care in hospitalized children ,2 years of age were included. Data were extracted and confirmed by multiple investigators and pooled by using a random effects model. Benchmarks were calculated by using achievable benchmarks of care methods. RESULTS:Fourteen studies involving .12 000 infants were reviewed. QI interventions resulted in 16 fewer patients exposed to repeated doses of bronchodilators per 100 hospitalized (7 studies) (risk difference: 0.16 [95% confidence interval: 0.11-0.21]) and resulted in 5.3 fewer doses of bronchodilator given per patient (95% confidence interval: 2

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“…Other types of treatment remain controversial: corticosteroid denied positive effect in wheezing and hospitalisation rate (3,4), adrenergic agents used did not assure univocal results (3,(5)(6)(7). The use ofnebulized hypertonic saline solution (HS) was demonstrated to be effective to decrease symptoms (8,9) and length of hospitalization in association to~-adrenergic drugs (9,10).…”

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confidence: 99%

Effectiveness of Nebulized Hypertonic Saline and Epinephrine in Hospitalized Infants with Bronchiolitis

Giudice

Saitta²,

Leonardi

et al. 2012

Int J Immunopathol Pharmacol

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The objective of the study is to verify effects of nebulized 3% saline hypertonic solution (HS) in comparison to normal saline (NS) in addition to epinephrine in hospitalized children with bronchiolitis. Infants were randomly assigned either to receive every 6 hours nebulized NS (group I) or 3% HS (group II) in addition to epinephrine (1.5 mg) and to conventional treatment. The main endpoints of this study were the length of stay (LOS) in hospital and the clinical response score (CSS). Patients presented a significant decrease in CSS from the first through the third day of treatment, present in the first group but even more evident in the second group (p=0.0001). Comparison between group I and II data shows significant decrease in CSS in the 3% HS-treated patients both at the second (p<0.005) and at the third day of treatment (p<0.005). Infants in the NS control group had a mean LOS of 5.6±1.6 days, whereas children treated with 3% HS were discharged with a LOS of 4.9±1.3 days, reaching a significant decrease in stay (p<0.05). In hospitalized patients bronchiolitis nebulized 3% HS and epinephrine significantly decreased symptoms and LOS as compared to 0.9% NS and epinephrine.

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Bronchodilators for bronchiolitis

Cited by 98 publications

References 77 publications

Maybe there is no such thing as bronchiolitis

Maybe there is no such thing as bronchiolitis

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

Effectiveness of Nebulized Hypertonic Saline and Epinephrine in Hospitalized Infants with Bronchiolitis

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