Recent evidence on the management of bronchiolitis

Abstract

Purpose of Review Bronchiolitis is a common condition in children < 2 years and is a leading cause of infant hospitalization. While there is significant variability in testing and treatment of children with bronchiolitis, diagnostic testing rarely improves care, and no currently available pharmacologic options have been proven to provide meaningful benefit or improve outcomes. Recent Findings Beta-agonists continue to be used frequently despite evidence that they do not reduce hospital admissions or length-of-stay. In general, therapies initially considered promising were subsequently proven ineffective, a pattern seen in studies on corticosteroids, and more recently with nebulized racemic epinephrine and hypertonic saline. Recent research has improved our understanding of the viral epidemiology of bronchiolitis, with increasing recognition of viruses other than respiratory syncytial virus and better awareness of the role of viral co-infections. How these findings will translate into improved outcomes remains uncertain. Summary Much of the emphasis of the last few decades of bronchiolitis clinical care and research has centered on the identification and testing of novel therapies. Future quality improvement efforts should focus more on the limitation of unnecessary testing and treatments. Future research should include identification of subgroups of children with bronchiolitis that may benefit from focused clinical interventions.

A clustering approach to identify severe bronchiolitis profiles in children

“…[2] Bronchodilator and corticosteroid therapies are generally considered ineffective in bronchiolitis management, but the possibility that they may be beneficial in specific subgroups of patients has been suggested by several investigators worldwide. [22,23,25,35,36]…”

“…[3,5] However, to date, no consensus has emerged regarding the definition of subgroups of children with bronchiolitis who may respond differently to medications and/or have different short- or long-term outcomes. [22–26]…”

A Clustering Approach to Identify Severe Bronchiolitis Profiles in Children

“…[2] Bronchodilator and corticosteroid therapies are generally considered ineffective in bronchiolitis management, but the possibility that they may be beneficial in specific subgroups of patients has been suggested by several investigators worldwide. [22,23,25,35,36] Bronchiolitis severity is another characteristic that has been independently associated with higher risk for development of childhood asthma. [16,17] The severity of bronchiolitis may also be a marker of a predisposition to develop childhood asthma, or actually play an etiologic role in its development.…”

“…[3,5] However, to date, no consensus has emerged regarding the definition of subgroups of children with bronchiolitis who may respond differently to medications and/or have different short-or long-term outcomes. [22][23][24][25][26] Clustering statistical methods are useful to identify profiles that summarize shared aspects of a disease within different groups of affected patients. Latent class analysis (LCA) is a "hypothesis-free" approach, used to identify more homogeneous subgroups of patients from a large set of observed clinical characteristics.…”

Changes in serum phosphorous level during inpatient treatment of children with severe acute malnutrition

“…2,3 None of the tried treatments have been proven to significantly alter the course of disease. 4 3% hypertonic saline too has been tried in bronchiolitis and found to alter the duration of the disease and clinical severity in some studies. 5 Since the treatment of bronchiolitis is mainly supportive we decided to work on the morbidity part and also to find out if there is any significant difference in the length of stay, cough resolution time and wheeze resolution time.…”