Early nebulized budesonide in the treatment of bronchiolitis and the prevention of postbronchiolitic wheezing

Richter, Hazel; Seddon, Paul

doi:10.1016/s0022-3476(98)70316-6

Cited by 121 publications

(63 citation statements)

References 22 publications

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“…The results are not consistent, although most follow-up studies report negative results [20,21,24,102,103]. In a British study, early treatment with nebulized budesonide for 6 weeks neither decreased acute bronchiolitis symptoms (83% RSV positive) nor prevented postbronchiolitic wheezing during the following 6 months [20]. In a Danish study, oral prednisolone treatment of children v24 months of age, hospitalized because of acute RSV infection, had no effect on outcome measures, either in the acute phase or in follow-ups, 1 month and 1 yr after admission to hospital [21].…”

Section: Vaccinesmentioning

confidence: 74%

“…Table 3 summarizes these studies. The results are not consistent, although most follow-up studies report negative results [20,21,24,102,103]. In a British study, early treatment with nebulized budesonide for 6 weeks neither decreased acute bronchiolitis symptoms (83% RSV positive) nor prevented postbronchiolitic wheezing during the following 6 months [20].…”

Section: Vaccinesmentioning

confidence: 95%

“…In fact, there are four double-blind, RCT studies that report a better effect of inhaled adrenaline or racemic adrenaline, compared to salbutamol, in the treatment of acute bronchiolitis in infants [16][17][18][19]. In contrast, almost all placebo-controlled studies on the use of corticosteroids, given by systemic administration or inhalation, show no improvement in the clinical course of acute bronchiolitis [20][21][22][23][24]. VAN WOENSEL et al [25] found that oral prednisolone seemed to accelerate the clinical recovery of children admitted to hospital with RSV bronchiolitis, but the results of that study are an exception.…”

mentioning

confidence: 99%

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Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Wennergren¹,

Kristjánsson²

2001

European Respiratory Journal

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Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases. G. Wennergren, S. Kristjánsson. #ERS Journals Ltd 2001. ABSTRACT: Evidence from a large number of prospective case-control studies shows that respiratory syncytial virus (RSV) bronchiolitis in infancy is often associated with recurrent wheezing and asthma during subsequent years. However, wheezing tends to diminish and most studies show no significant increase in wheezing compared to controls by school age or adolescence. An unresolved question is whether severe RSV infection during infancy causes the respiratory sequelae or inherent abnormalities predispose an infant to develop severe respiratory infection and sequelae, i.e. RSV is associated with the development of pulmonary sequelae.Studies on long-term outcome of RSV bronchiolitis are reviewed from an evidencebased perspective.The majority of prospective placebo-controlled studies do not show any long-term beneficial effects of corticosteroid treatment, i.e. the risk of subsequent wheezing is not diminished by the treatment. The evidence for an increased risk of allergic sensitization after RSV bronchiolitis is not nearly as strong as the evidence for an increased risk of subsequent wheezing. In fact, most studies do not show any significant increase in atopy after RSV bronchiolitis. This suggests that the increased risk of wheezing after RSV is not linked to an increased risk of atopy. There are some indications that infants who develop severe RSV and subsequent wheezing may have aberrations that predate the RSV infection.To decide whether respiratory syncytial virus bronchiolitis causes, or is associated with the respiratory sequelae (or with subsequent allergy), it will be necessary to conduct prospective, randomized studies, where the cytokine profile prior to bronchiolitis onset is known. Such studies should preferably include some form of intervention against respiratory syncytial virus. A more complete understanding of the risk factors for severe respiratory syncytial virus infection and the role of respiratory syncytial virus infection in the initiation of asthma is needed as a basis for large-scale and cost-effective programmes to prevent respiratory syncytial virus-related morbidity. Eur Respir J 2001; 18: 1044-1058. Respiratory syncytial virus (RSV) bronchiolitis is the most common, severe lower respiratory tract infection in infancy. It now seems well established that RSV bronchiolitis in infancy is associated with recurrent wheezing and asthma during the first decade of life. In some children, wheezing after early lower airway infection with RSV is transient, but in many of the children RSV-induced bronchiolitis represents the onset of asthma. In fact, there are results which indicate that severe RSV bronchiolitis in the young infant may shift the T-helper (Th)1/Th2 balance in favour of a Th2 cytokine pattern, leading to development of allergic sensitization and persistent asthma [1,2]. However, the association with risk of development of atopy...

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Section: Vaccinesmentioning

confidence: 74%

Section: Vaccinesmentioning

confidence: 95%

mentioning

confidence: 99%

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Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Wennergren¹,

Kristjánsson²

2001

European Respiratory Journal

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“…No effect of inhaled corticosteroids was seen on clinical scores or length of hospitalisation [124][125][126]. There is no evidence that inhaled corticosteroids prevent recurrent wheeze following AVB [127,128].…”

Section: Inhaled Corticosteroidsmentioning

confidence: 97%

Medicines used in respiratory diseases only seen in children

Lenney¹,

Al²,

Bont³

et al. 2009

European Respiratory Journal

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Detailed literature searches were carried out in seven respiratory disease areas. Therapeutic evidence for efficacy of medicinal products was assessed using the Grades of Recommendation, Assessment and Evaluation (GRADE) methodology, as well as an assessment of safety and side-effects.Systemic corticosteroids may reduce the development of bronchopulmonary dysplasia but have serious side-effects. Antioxidants need further study to demonstrate whether they have long-term benefits. Treatments for acute bronchiolitis have shown little benefit but new antiviral and monoclonal antibodies need further assessment. Well-constructed studies are needed to confirm the value of inhaled corticosteroids and/or montelukast in the management of viralinduced wheeze. Corticosteroids are the treatment of choice in croup. Minimal or no information is available for the treatment of congenital lung abnormalities, bronchiolitis obliterans and interstitial lung disease.

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“…Richter e cols. 40 , em um estudo randomizado, duplo cego, placebo controlado, reavaliaram essa possibilidade. Não foram capazes de encontrar benefícios num grupo de 21 lactentes portadores de bronquiolite viral aguda, que fizeram uso de budesonide por via inalatória.…”

Section: Corticosteróidesunclassified

Acute viral bronchiolitis - still subject for controversy

Amantéa¹,

Silva²

1998

J Pediatr (Rio J)

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ResumoObjetivos: Os autores apresentam uma revisão sobre bronquiolite viral aguda, salientando os aspectos, ainda controversos, relacionados à terapêutica da doença. Além dessas questões teóricas, referidas pela literatura, procuram estabelecer um juízo crítico acerca do assunto, referindo suas posições pessoais frente ao manejo dessa doença.Métodos: Foram selecionados, a partir de uma pesquisa no banco de dados da Medline, os artigos que julgamos mais significativos acerca do tema, publicados na literatura médica nos últimos 20 anos.Resultados: Bronquiolite viral aguda é a doença infecciosa do trato respiratório inferior mais freqüente no primeiro ano de idade. Apesar da sua significativa prevalência e de todo o risco que tal situação pode conferir aos pacientes nessa faixa etária, muito pouco evoluímos acerca da terapêutica empregada nessa situação clínica. Cada vez mais encontramos fundamentada a importância de uma hidratação adequada, dos cuidados necessários para prevenir infecção cruzada e da importância da oxigenoterapia. Muitas dúvidas persistem com relação ao papel das drogas broncodilatadoras e antivirais (ribavirina). Algumas perspectivas se abrem com o emprego de imunoglobulinas específicas, principalmente na prevenção da doença pelo vírus sincicial respiratório em populações de risco. Cada vez menos, encontramos justificada, a utilização de corticosteróides na fase aguda da doença.Conclusões: Bronquiolite viral aguda é uma doença que ainda carece de um tratamento ideal. As rotinas por nós empregadas pouco mudaram nos últimos 30 anos, o que faz com que haja muita controvérsia, acerca da terapêutica a ser utilizada entre os mais diversos centros de assistência.J. pediatr. (Rio J.). 1998; 74 (Supl.1): S37-S47: bronquiolite, vírus sincicial respiratório, ribavirina, broncodilatador. AbstractObjectives: The authors review the current literature on acute viral bronchiolitis discussing the points still subject to controversy in regard to its treatment. At the same time, a personal point of view on the management of this disorder based on the authors´ experience is also expressed.Methods: The main published papers from the last twenty years were selected from a Medline database search.

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Early nebulized budesonide in the treatment of bronchiolitis and the prevention of postbronchiolitic wheezing

Cited by 121 publications

References 22 publications

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Medicines used in respiratory diseases only seen in children

Acute viral bronchiolitis - still subject for controversy

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