Corticosteroid Therapy During Acute Bronchiolitis in Patients Who Later Develop Asthma

Shein, Steven L.; Rotta, Alexandre T.; Speicher, Richard; Slain, Katherine; Gaston, Benjamin

doi:10.1542/hpeds.2016-0211

Cited by 9 publications

(4 citation statements)

References 32 publications

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“…Despite its high prevalence, there are no effective therapies for bronchiolitis . Corticosteroids are often administered despite lack of efficacy in meta‐analyses, possibly influenced by clinicians’ belief that the particular patient may have a predilection towards asthma . The ability for clinicians to identify a corticosteroid‐responsive subset of bronchiolitis patients is supported by one randomized trial in which corticosteroids reduced hospital length of stay in children with eczema or familial asthma, but other studies do not show benefits in similar sub‐populations .…”

Section: Introductionmentioning

confidence: 99%

Periostin levels in children without respiratory disease

O'Connell

Gaston

Bonfield

et al. 2018

Pediatric Pulmonology

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Background: Periostin is a protein that serves as a downstream marker of the T-helper type 2 (Th2) cell response. It may serve to identify drug-responsive inflammatory phenotypes, particularly in children with asthma and possibly bronchiolitis. There are no published levels of periostin in healthy children <2 years of age, limiting interpretation of periostin levels in disease. We sought to explore the range of periostin levels of children <2 years without significant confounding illnesses.Methods: Children undergoing clinically indicated phlebotomy or having a peripheral intravenous catheter inserted prior to general anesthesia or procedural sedation were enrolled. A 0.5 mL sample of blood was collected and frozen at −70°C. After thawing, periostin was measured with a Luminex assay (R&D Systems, Minneapolis, MN).Medical record review and/or parental interview elicited potential variables associated with periostin. Association was evaluated using Mann-Whitney rank sum test, Kruskal-Wallis ANOVA, and Spearman correlation as appropriate.Results: Among 43 children (23 male, 20 female, age range 9-15.7 months), periostin levels were inversely correlated to age (r = −0.438, P = 0.003). Periostin levels also differed significantly between children <12mo (734.0 [576.6-906.5] ng/mL), 12-18mo (645.1 [363.8-538.2] ng/mL) and >18mo (416.4 [363.8-538.15] ng/mL) (P < 0.001). Conclusion:In our sample of relatively healthy patients <2 years old, periostin levels were inversely correlated with age and not dependent on other studied variables.However, further work is needed to establish normal periostin values in young children. K E Y W O R D S asthma, bronchiolitis, children, periostin

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Section: Introductionmentioning

confidence: 99%

Periostin levels in children without respiratory disease

O'Connell

Gaston

Bonfield

et al. 2018

Pediatric Pulmonology

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“…Multiple previous studies and reviews have conflicting results of the benefit of steroids in bronchiolitis. [18][19][20][21] Cochrane systematic review and multiple guidelines have concluded that glucocorticoids do not improve clinical respiratory scores, hospitalisations rates or LOS, and do not recommend use of glucocorticoids or salbutamol in bronchiolitis. 5,7,8,22,23 In our audit, whilst <1% of infants in-hospital received glucocorticoids, clinicians in the prehospital settings administered the majority of steroids.…”

Section: Discussionmentioning

confidence: 99%

“…Principal diagnosis of bronchiolitis from ED was searched using the ED Information System (EDIS, Version 9.46.1001 ER15, HAS Solutions Pty Limited, Australia) with diagnostic codes of bronchiolitis (ICD10 codes: J21.0, J21.1, J21.8, J21.9 or ICD9 code: 466. 19). Principal diagnosis of bronchiolitis from the inpatient ward was confirmed on patient's discharge summary and/or inpatient notes.…”

Section: Methodsmentioning

confidence: 99%

Knowledge translation in Western Australia tertiary paediatric emergency department: An audit cycle of effectiveness of guideline dissemination on bronchiolitis management

Yeo

O’Brien

Bear

et al. 2020

J Paediatrics Child Health

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Aim Bronchiolitis is the commonest cause of hospitalisation for infants. Evidence‐based Australasian bronchiolitis guideline was developed and introduced in 2017. This audit was to determine if the knowledge translation process of the updated local tertiary hospital bronchiolitis guideline (based on the Australasian guideline) reduced unnecessary interventions. Methods A retrospective chart review of infants with bronchiolitis diagnosis during the pre‐guideline (1 July to 31 August 2015) and post‐guideline (1 July to 31 August 2017) period, with the primary outcome of the number/proportion of unnecessary interventions. Results Presentations between 1 July to 31 August 2015 (n = 465) were compared with 2017 (n = 343). There was no difference in undertaking chest X‐ray (24 (5.2%) vs. 17 (5.0%), odds ratio (OR) 0.98 (95% confidence interval (CI) 0.71–1.35), P = 0.911), salbutamol (23 (4.9%) vs. 10 (2.9%), OR 0.86 (95% CI 0.65–1.13), P = 0.279), glucocorticoids (2 (0.4%) vs. 5 (1.5%), OR 1.89 (95% CI 0.83–4.31), p = 0.129), antibiotics (11 (2.4%) vs. 5 (1.5%), OR 0.86 (95% CI 0.65–1.15), P = 0.307) or nasopharyngeal aspirate (172 (37%) vs. 124 (36.2%), OR 1.00 (95% CI 0.87–1.67), P = 0.937) in hospital. Adrenaline was not administered in both years. There was reduced hospital admissions (303 (65.2%) vs. 192 (56.0%), OR 0.82 (95% CI 0.71–0.95), P = 0.008) with no difference in paediatric intensive care unit admissions (10 (2.2%) vs. 8 (2.3%), OR 1.04 (95% CI 0.65–1.67), P = 0.863). Conclusion The dissemination process of the updated local hospital bronchiolitis guideline did not show any statistically significant reduction of unnecessary interventions in the hospital. Further studies are required to determine the effective process to instigate changes in health services.

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“…Both treatments do not prevent hospital admission and do not improve short-and long-term outcomes in patients with bronchiolitis or the length of hospital stay. Changes in timing, dosage or duration of treatment do not influence the effects of nebulized and systemic steroids [1,20,95,[99][100][101][102][103][104].…”

Section: Nebulized Adrenalinementioning

confidence: 99%

UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants

et al. 2023

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Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children. This document aims to update the consensus document published in 2014 to provide guidance on the current best practices for managing bronchiolitis in infants. The document addresses care in both hospitals and primary care. The diagnosis of bronchiolitis is based on the clinical history and physical examination. The mainstays of management are largely supportive, consisting of fluid management and respiratory support. Evidence suggests no benefit with the use of salbutamol, glucocorticosteroids and antibiotics with potential risk of harm. Because of the lack of effective treatment, the reduction of morbidity must rely on preventive measures. De-implementation of non-evidence-based interventions is a major goal, and educational interventions for clinicians should be carried out to promote high-value care of infants with bronchiolitis. Well-prepared implementation strategies to standardize care and improve the quality of care are needed to promote adherence to guidelines and discourage non-evidence-based attitudes. In parallel, parents' education will help reduce patient pressure and contribute to inappropriate prescriptions. Infants with pre-existing risk factors (i.e., prematurity, bronchopulmonary dysplasia, congenital heart diseases, immunodeficiency, neuromuscular diseases, cystic fibrosis, Down syndrome) present a significant risk of severe bronchiolitis and should be carefully assessed. This revised document, based on international and national scientific evidence, reinforces the current recommendations and integrates the recent advances for optimal care and prevention of acute bronchiolitis.

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Corticosteroid Therapy During Acute Bronchiolitis in Patients Who Later Develop Asthma

Abstract: Corticosteroids were not associated with improved outcome in patients with bronchiolitis who were later hospitalized with asthma. Moderately ill patients with no comorbidities may warrant further study.

Cited by 9 publications

References 32 publications

Periostin levels in children without respiratory disease

Periostin levels in children without respiratory disease

Knowledge translation in Western Australia tertiary paediatric emergency department: An audit cycle of effectiveness of guideline dissemination on bronchiolitis management

UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants

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