Bronchodilators for bronchiolitis

Gadomski, Anne; Scribani, Melissa

doi:10.1002/14651858.cd001266.pub4

Cited by 253 publications

(146 citation statements)

References 101 publications

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“…Furthermore, there was significant variation in the choice of nebulised treatment, from 23% of patients who did not receive any inhaled therapy to 40.8% of patients who received several types of inhaled medication during a single stay. Bronchodilators, salbutamol or adrenaline, have not been shown to improve outcomes, admission rate, or duration of hospitalisation in these patients [22, 23]. In our study, nebulised adrenaline was chosen as the main bronchodilator, likely based on articles that showed a slight short-term improvement in some clinical parameters [24].…”

Section: Discussionmentioning

confidence: 99%

Prospective Multicentre Study on the Epidemiology and Current Therapeutic Management of Severe Bronchiolitis in Spain

Flores-González

Mayordomo-Colunga

Jordán

et al. 2017

BioMed Research International

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Objective. To determine the epidemiology and therapeutic management of patients with severe acute bronchiolitis (AB) admitted to paediatric intensive care units (PICUs) in Spain. Design. Descriptive, prospective, multicentre study. Setting. Sixteen Spanish PICUs. Patients. Patients with severe AB who required admission to any of the participating PICUs over 1 year. Interventions. Both epidemiological variables and medical treatment received were recorded. Results. A total of 262 patients were recruited; 143 were male (54.6%), with median age of 1 month (0–23). Median stay in the PICU was 7 days (1–46). Sixty patients (23%) received no nebuliser treatment, while the rest received a combination of inhalation therapies. One-quarter of patients (24.8%) received corticosteroids and 56.5% antibiotic therapy. High-flow oxygen therapy was used in 14.3% and noninvasive ventilation (NIV) was used in 75.6%. Endotracheal intubation was required in 24.4% of patients. Younger age, antibiotic therapy, and invasive mechanical ventilation (IMV) were risk factors that significantly increased the stay in the PICU. Conclusions. Spanish PICUs continue to routinely use nebulised bronchodilator treatment and corticosteroid therapy. Despite NIV being widely used in this condition, intubation was required in one-quarter of cases. Younger age, antibiotic therapy, and IMV were associated with a longer stay in the PICU.

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Section: Discussionmentioning

confidence: 99%

Prospective Multicentre Study on the Epidemiology and Current Therapeutic Management of Severe Bronchiolitis in Spain

Flores-González

Mayordomo-Colunga

Jordán

et al. 2017

BioMed Research International

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“…Current evidence is largely based on clinical trials of specific interventions (e.g., bronchodilators, corticosteroids) with mixed results, and an underlying assumption that bronchiolitis is a single disease entity with similar clinical characteristics, causes, and mechanisms [1]. As the inferences were based on the group mean data from populations that might include different subgroups [14,15], even after excluding large numbers of children with physician-diagnosed bronchiolitis (e.g., children with non-RSV bronchiolitis, history of prior breathing problems, age older than 1 year), the current evidence might have failed to encompass differences in efficacy and safety profiles.…”

Section: Heterogeneity Of Bronchiolitismentioning

confidence: 99%

Advancing our understanding of infant bronchiolitis through phenotyping and endotyping: clinical and molecular approaches

Hasegawa

Dumas

Hartert

et al. 2016

Expert Review of Respiratory Medicine

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Introduction Bronchiolitis is a major public health problem worldwide. However, no effective treatment strategies are available, other than supportive care. Areas Covered Although bronchiolitis has been considered a single disease diagnosed based on clinical characteristics, emerging evidence supports both clinical and pathobiological heterogeneity. The characterization of this heterogeneity supports the concept that bronchiolitis consists of multiple phenotypes or consistent grouping of characteristics. Expert Commentary Using unbiased statistical approaches, multidimentional clinical characteristics will derive bronchiolitis phenotypes. Furthermore, molecular and systems biology approaches will, by linking pathobiology to phenotype, identify endotypes. Large cohort studies of bronchiolitis with comprehensive clinical characterization and system-wide profiling of the “-omics” data (e.g., host genome, transcriptome, epigenome, viral genome, microbiome, metabolome) should enhance our ability to molecularly understand these phenotypes and lead to more targeted and personalized approaches to bronchiolitis treatment.

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“…However, it is worrying 34% of respondents prescribe a medication because they believe there is good evidence it helps the infant. There is clear evidence from systematic reviews, noted in the NICE guideline, that medications including bronchodilators,5 corticosteroids,6 leukotriene receptor antagonists7 and antibiotics8 are not efficacious. More widespread use of, and familiarity with, the NICE guideline could potentially improve GPs’ knowledge and thus clinical practice in this area.…”

Section: Discussionmentioning

confidence: 99%

Change in viral bronchiolitis management in primary care in the UK after the publication of NICE guideline

Carande

Cheung

Pollard

et al. 2018

Thorax

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The aim of this study was to investigate changes in general practitioner (GP) management before and after the publication of the National Institute for Health and Care Excellence bronchiolitis guideline. In March 2015 and May 2016, an electronic questionnaire was sent to GPs. It was completed by 1001 GPs in 2015 and 1009 in 2016. There were small but significant improvements in proportions of GPs using a guideline, measuring oxygen saturations and providing written guidance, and appropriate reductions in those prescribing medications. Thirty-five per cent had read the guideline and 25% changed their practice since guideline publication. There were modest but significant improvements in reported management by GPs after guideline publication.

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Bronchodilators for bronchiolitis

Abstract: Thompson 1994 Thompson SG. Why sources of heterogeneity in meta-analysis should be investigated?.

Cited by 253 publications

References 101 publications

Prospective Multicentre Study on the Epidemiology and Current Therapeutic Management of Severe Bronchiolitis in Spain

Prospective Multicentre Study on the Epidemiology and Current Therapeutic Management of Severe Bronchiolitis in Spain

Advancing our understanding of infant bronchiolitis through phenotyping and endotyping: clinical and molecular approaches

Change in viral bronchiolitis management in primary care in the UK after the publication of NICE guideline

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