Oral versus nebulized albuterol in the management of bronchiolitis in Egypt

Gadomski, Anne; Aref, G H; Din, Omneya Badr el; Sawy, Ihab Hafez el; Khallaf, Nagwa; Black, Robert E.

doi:10.1016/s0022-3476(94)70269-1

Cited by 81 publications

(70 citation statements)

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“…Clinical score, but not oxygen saturation, was significantly improved at 30 minutes, but no difference was demonstrated 60 minutes after a treatment. Gadomski et al 54 showed no difference between those in groups on albuterol or placebo after 2 nebulized treatments given 30 minutes apart.…”

Section: Recommendation 2b a Carefully Monitored Trial Of ␣-Adrenergimentioning

confidence: 97%

“…Individuals and institutions should assess the patient and document pretherapy and posttherapy changes using an objective means of evaluation. Some of the documentation tools that have been used can be found in articles by Alario et al, 45 Bierman and Pierson, 63 Gadomski et al, 54 Lowell et al, 33 Wainwright et al, 51 Schuh et al, 64 and Gorelick et al 65 In addition, a documentation tool has been developed by Cincinnati Children's Hospital (Cincinnati, OH). 66 Extrapolation from the studies discussed above suggests that epinephrine may be the preferred bronchodilator for this trial in the emergency department and in hospitalized patients.…”

Section: Epinephrine/adrenalinementioning

confidence: 99%

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Diagnosis and Management of Bronchiolitis

2006

Pediatrics

885

293

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Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm.The American Academy of Pediatrics convened a committee composed of primary care physicians and specialists in the fields of pulmonology, infectious disease, emergency medicine, epidemiology, and medical informatics. The committee partnered with the Agency for Healthcare Research and Quality and the RTI International-University of North Carolina Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to the diagnosis, management, and prevention of bronchiolitis. The resulting evidence report and other sources of data were used to formulate clinical practice guideline recommendations.This guideline addresses the diagnosis of bronchiolitis as well as various therapeutic interventions including bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physiotherapy, and oxygen. Recommendations are made for prevention of respiratory syncytial virus infection with palivizumab and the control of nosocomial spread of infection. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent comprehensive peer review before it was approved by the American Academy of Pediatrics.This clinical practice guideline is not intended as a sole source of guidance in the management of children with bronchiolitis. Rather, it is intended to assist clinicians in decision-making. It is not intended to replace clinical judgment or establish a protocol for the care of all children with this condition. These recommendations may not provide the only appropriate approach to the management of children with bronchiolitis. INTRODUCTIONTHIS GUIDELINE EXAMINES the published evidence on diagnosis and acute management of the child with bronchiolitis in both outpatient and hospital settings, including the roles of supportive therapy, oxygen, bronchodilators, antiinflammatory agents, antibacterial agents, and antiviral agents and make recommendations to influence clinician behavior on the basis of the evidence. Methods of prevention All clinical practice guidelines from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of care. Variations, taking into account individual circumstances, may be appropriate. Key Word bronchiolitisAbbreviations CAM-complementary and alternative medicine LRTI-lower respiratory tract infection AHRQ-Agency for Healthcare Research and Quality RSV-respiratory syncytial virus AAP-American Academy of Pediatrics AAFP-American Academy...

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Section: Recommendation 2b a Carefully Monitored Trial Of ␣-Adrenergimentioning

confidence: 97%

Section: Epinephrine/adrenalinementioning

confidence: 99%

Diagnosis and Management of Bronchiolitis

2006

Pediatrics

885

293

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“…18 -22 These data, however, are balanced with a meta-analysis and several trials that fail to show any effects. [23][24][25][26][27] Epinephrine has received the most …”

mentioning

confidence: 99%

“…18 -22 These data, however, are balanced with a meta-analysis and several trials that fail to show any effects. [23][24][25][26][27] Epinephrine has received the most consistent support from clinical trials 28 -32 ; however, its benefits are limited and it is not yet widely prescribed for inhalation outside the hospital setting. Despite the conflicting evidence regarding bronchodilators for bronchiolitis, previous studies have demonstrated that physicians favor their use.…”

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confidence: 99%

Bronchiolitis Management Preferences and the Influence of Pulse Oximetry and Respiratory Rate on the Decision to Admit

et al. 2003

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ABSTRACT. Objective. High incidence, rising admission rates, and relatively ineffective therapies make the management of bronchiolitis controversial. Since 1980, the rate of hospitalization for children with bronchiolitis has increased by nearly 250%, whereas mortality rates for the disease have remained constant. It has been speculated that the increasing use of pulse oximetry has lowered the threshold for admission and may have contributed to the rise in bronchiolitis-related admissions. The objective of this study was to describe pediatric emergency medicine physicians' management preferences regarding infants with moderately severe bronchiolitis and to assess the influence of specific differences in oxygen saturation as measured by pulse oximetry (SpO 2 ) and respiratory rate (RR) on the decision to admit.Methods. Physicians who are members of the American Academy of Pediatrics Section of Emergency Medicine and living in the United States were randomized into 4 groups and mailed a survey that contained 1 of 4 vignettes. Vignettes were identical except for given SpO 2 values (94% or 92%) and RR (50/min or 65/min). Subjects were asked to answer questions regarding laboratory tests, treatment options, and the decision to admit for the patient in their vignette.Results. We received completed surveys from 519 (64%) of the 812 physicians contacted. Most respondents recommended use of bronchodilators (96%), nasal suction (82%), and supplemental oxygen (57%). Few respondents recommended decongestants (9%), steroids (8%), or antibiotics (2%). When asked to rank therapies, respondents gave nasal suction 182 number 1 votes; bronchodilators received 164. The decision to admit varied with SpO 2 and RR. Forty-three percent of respondents who received a vignette featuring SpO 2 of 94% and a RR of 50/min recommended admission for the infant in their vignette. Fifty-eight percent recommended admission when the vignette SpO 2 was 94% and RR was 65/min ( 2 ‫؍‬ 5.021). Respondents who received a vignette with SpO 2 of 92% were nearly twice as likely to recommend admission: 83% recommended admission when vignette RR was 50/min, and 85% recommended admission when vignette RR was 65/min ( 2 ‫؍‬ 0.126).Conclusions. When treating infants with moderately severe bronchiolitis, pediatricians who work in emergency departments frequently use bronchodilators and nasal suction, 2 practices for which supporting data are either conflicting (bronchodilators) or nonexistent (nasal suction). In addition, their decisions to admit differ markedly on the basis of only a 2% difference in SpO 2 . It is possible that increased reliance on pulse oximetry has contributed to the increase in bronchiolitis hospitalization rates seen during the past 2 decades. Pediatrics 2003;111:e45-e51. URL: http://www.pediatrics.org/cgi/ content/full/111/1/e45; bronchiolitis, bronchodilators, steroids, nasal suction, pulse oximetry, practice variation.ABBREVIATIONS. Spo 2 , oxygen saturation as measured by pulse oximetry; RR, respiratory rate; RSV, respiratory syncytial...

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“…Somehow, even after 30 years and many trials with bronchodilators, a consensus on their use in the management of bronchiolitis remains elusive till date though salbutamol is widely used for WARI. A variety of agents ranging from parenteral epinephrine to nebulised racemic epinephrine, albuterol, salbutamol and routinely available laevo-epinephrine have been tried [14][15]. The interest in epinephrine has been significant owing to the following: (i) α − adrenergic vasoconstrictor action that can decongest the mucosa, limit its own absorption and regulate pulmonary blood flow, with little effect on ventilation-perfusion matching (ii) β2-adrenergic bronchial muscle relaxant effect (iii) β-adrenergic action to suppress release of chemical mediators (iv) physiological antihistamine effect that can reverse histamine effects, such as edema and (v) reduction of catarrhal secretions [16,17].…”

Section: Discussionmentioning

confidence: 99%

Comparision of Nebulised Salbutamol and L-epinephrine in First Time Wheezy Children

John¹,

Singh²

2010

Medical Journal Armed Forces India

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Background: Salbutamol is the standard recommendation in bronchial asthma. However, the use of bronchodilators in wheeze associated respiratory infections including bronchiolitis continues to be controversial. The aim of this study was to compare the efficacy of nebulised salbutamol versus epinephrine in 'first time' wheezy children using clinical parameters and airway resistance. Methods: Sixty children between two months to 60 months were recruited, 30 in each treatment group. Children received periodic (0, 20, 40 minutes) doses of either salbutamol (0.15mg/kg with 3ml saline subject to a minimum of 2.5mg) or laevo-epinephrine (1:1000, 0.5ml/kg subject to a max of 2.5ml with 3ml saline) via nebuliser along with oxygen. Changes in heart rate (HR), oxygen saturation (SpO 2 ), respiratory rate (RR) and respiratory distress assessment instrument (RDAI) were assessed along with measurement of airway resistance using interrupter method (Hand held spirometer-Microloop with MicroRint module). Result: The respiratory status was better in the epinephrine group with significant improvement in RR, RDAI score, SpO 2 and fall of airway resistance. There were no significant side effects noted in either group. Conclusion: Nebulised epinephrine is a useful and safe drug for wheezy children and is superior to salbutamol. This needs validation by large multicentric randomized blinded studies. MJAFI 2010; 66 : 9-13

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Oral versus nebulized albuterol in the management of bronchiolitis in Egypt

Cited by 81 publications

References 35 publications

Diagnosis and Management of Bronchiolitis

Diagnosis and Management of Bronchiolitis

Bronchiolitis Management Preferences and the Influence of Pulse Oximetry and Respiratory Rate on the Decision to Admit

Comparision of Nebulised Salbutamol and L-epinephrine in First Time Wheezy Children

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