Glucocorticoids for acute viral bronchiolitis in infants and young children

Patel, Hema; Platt, R; Lozano, J M; Wang, EEL

doi:10.1002/14651858.cd004878

Cited by 117 publications

(94 citation statements)

References 61 publications

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“…In cases of edema, hypersecretion, bronchoconstriction are treatable by applying CP and/or aerosol medications. Remembering that children with AVB hissing but that the pathophysiology of bronchiolitis and asthma is distinct from these infants who are less responsive to bronchodilators or steroids [43][44][45] . They are also widely used despite the presence of studies 43,45 which have found no evidence for such therapies.…”

Section: Discussionmentioning

confidence: 99%

“…Remembering that children with AVB hissing but that the pathophysiology of bronchiolitis and asthma is distinct from these infants who are less responsive to bronchodilators or steroids [43][44][45] . They are also widely used despite the presence of studies 43,45 which have found no evidence for such therapies. The primary goal of CP in these infants is to reduce secretion obstruction and secondly respiratory distress which is a consequence of obstruction with subsequent improvement on hyperinflation and respiratory distress.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Gomes¹,

Postiaux²,

Medeiros³

et al. 2012

Rev. bras. fisioter.

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Objective: To evaluate the effectiveness of chest physical therapy (CP) in reducing the clinical score in infants with acute viral bronchiolitis (AVB). Methods: Randomized controlled trial of 30 previously healthy infants (mean age 4.08 SD 3.0 months) with AVB and positive for respiratory syncytial virus (RSV), evaluated at three moments: at admission, then at 48 and 72 hours after admission. The procedures were conducted by blinded assessors to each of three groups: G1 -new Chest Physical therapy-nCPT (Prolonged slow expiration -PSE and Clearance rhinopharyngeal retrograde -CRR), G2 -conventional Chest Physical therapy-cCPT (modified postural drainage, expiratory compression, vibration and percussion) and G3 -aspiration of the upper airways. The outcomes of interest were the Wang's clinical score (CS) and its components: Retractions (RE), Respiratory Rate (RR), Wheezing (WH) and General Conditions (GC). Results:The CS on admission was reduced in G1 (7.0-4.0) and G2 (7.5-5.5) but was unchanged in G3 (7.5-7.0). We observed a change 48 hours after hospitalization in G1 (5.5-3.0) and G2 (4.0-2.0) and in 72 hours, there was a change in G1 (2.0-1.0). Conclusion: The CP was effective in reducing the CS in infants with AVB compared with upper airway suction only. After 48 hours of admission, both techniques were effective and nCPT techniques were also effective in the 72 hours after hospitalization compared with cCPT techniques.Trial Registration NCT00884429-www.clinicaltrials.gov.Keywords: respiratory suncytial virus; bronchiolitis; physical therapy. ResumoObjetivo: Avaliar a efetividade da fisioterapia respiratória na redução do escore clínico em lactentes com bronquiolite viral aguda (BVA). Métodos: Ensaio controlado randomizado de 30 lactentes (média de idade 4,08±3,12 meses) com BVA, previamente hígidos, com vírus sincicial respiratório (VSR) positivo, avaliados em três momentos: admissão, 48 e 72 horas, antes e após os procedimentos por avaliadores cegos, em três grupos: G1 -técnicas atuais de fisioterapia (expiração lenta e prolongada e desobstrução rinofaríngea retrógrada), G2 -técnicas convencionais de fisioterapia (drenagem postural modificada, compressão expiratória, vibração e percussão) e G3 -aspiração de vias aéreas superiores por meio do escore clínico de Wang e seus componentes: retrações (RE), frequência respiratória (RR), sibilos (WH) e condições gerais (GC). Resultados: O escore clínico de Wang (CS) no momento admissão, no G1, reduziu de 7,0-4,0; no G2, de 7,5-5,5 e no G3 de 7,5-7,0, não apresentando alteração. No momento 48 horas, também houve alteração tanto no G1 (5,5-3,0) quanto no G2 (4,0-2,0) e, em 72 horas, apenas no G1 (2,0-1,0). Conclusão: A fisioterapia respiratória foi efetiva na redução do escore clínico em lactentes com BVA quando comparada com a aspiração isolada das vias aéreas na admissão. No momento 48 horas, ambas as técnicas foram efetivas, sendo que as técnicas atuais foram efetivas também nas 72 horas após a internação, comparada às técnicas convencionais.Registro de Ensa...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Gomes¹,

Postiaux²,

Medeiros³

et al. 2012

Rev. bras. fisioter.

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“…Glucocorticoids are in general use as broad spectrum anti-inflammatory agents, yet overall analysis suggests that they have only limited benefit for the treatment of severe hRSV associated inflammation [48]. Although we have not evaluated specific combinations of ribavirin and glucocorticoids in PVM infected mice, we have documented the effects of hydrocortisone alone on the inflammatory response.…”

Section: Glucocorticoidsmentioning

confidence: 97%

“…Three PVM-specific T cell epitopes were identified, including one in the P phosphoprotein (P 261-269 ), one in the M matrix protein (M [43][44][45][46][47][48][49][50][51] ) and one within the F fusion protein (F 304-312 ). Interestingly, the frequency of PVM-specific CD8+ T cells was relatively low, and only ~10 -20% of the P 261 -directed CD8+ T cells produced cytokines IFNγ and TNFα in response to appropriate stimulation, a deficient response similar to that characterized for RSV and Sv5 infections [40,41].…”

Section: T Cell Responsesmentioning

confidence: 99%

Pneumonia virus of mice: severe respiratory infection in a natural host

Rosenberg

Domachowske

2008

Immunology Letters

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Pneumonia virus of mice (PVM; family Paramyxoviridae, genus Pneumovirus) is a natural mouse pathogen that is closely related to the human and bovine respiratory syncytial viruses. Among the prominent features of this infection, robust replication of PVM takes place in bronchial epithelial cells in response to a minimal virus inoculum. Virus replication in situ results in local production of proinflammatory cytokines (MIP-1α, MIP-2, MCP-1 and IFNγ) and granulocyte recruitment to the lung. If left unchecked, PVM infection and the ensuing inflammatory response ultimately lead to pulmonary edema, respiratory compromise and death. In this review, we consider the recent studies using the PVM model that have provided important insights into the role of the inflammatory response in the pathogenesis of severe respiratory virus infection. We also highlight several works that have elucidated acquired immune responses to this pathogen, including T cell responses and the development of humoral immunity. Finally, we consider several immunomodulatory strategies that have been used successfully to reduce morbidity and mortality when administered to PVM infected, symptomatic mice, and thus hold promise as realistic therapeutic strategies for severe respiratory virus infections in human subjects.

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“…El repertorio de GPC National Guideline Clearinghouse acaba de publicar la sín-tesis comparativa de estas tres GPC que abordan un mismo problema de salud 4 . Se reconocen al menos las siguientes revisiones de la Cochrane sobre intervenciones en BA: adrenalina 5 , antibióti-cos 6 , beta-2-adrenérgicos 7,8 , bromuro de ipratropio 9,10 , corticoides [11][12][13][14] , fisioterapia 15,16 , inmunoglobulinas [17][18][19] , ribavirina 20,21 , suero salino hipertónico 22 y surfactante 23 . Considerando lo anteriormente expuesto, parece importante estudiar cómo se tratan las BA en nuestro medio, evaluando su variabilidad e idoneidad.…”

Section: Introductionunclassified