Use of Adrenergic Bronchodilators by Pediatric Allergists and Pulmonologists

Newcomb, Richard W.

doi:10.1001/archpedi.1989.02150160111022

Cited by 15 publications

(8 citation statements)

References 8 publications

(1 reference statement)

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“…A 1989 survey of US pediatric pulmonologists and allergists reported that 86% of respondents recommended a trial of bronchodilators for infants with bronchiolitis. 34 Since that time, the use of bronchodilators for bronchiolitis has been the subject of several meta-analyses. Kellner et al 22 found a modest short-term improvement associated with bronchodilator use, whereas Flores and Horwitz 27 concluded that there is insufficient data to support their use.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Despite the conflicting evidence regarding bronchodilators for bronchiolitis, previous studies have demonstrated that physicians favor their use. 33,34 We found no published studies that examined the role of nasal suction in the treatment of bronchiolitis.…”

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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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“…When compared with Canada, 10,31 the US 32 or other countries in Europe, 9 far fewer paediatricians in Australia routinely use pharmaceutical agents in the management of AVB. This difference may be due to guidelines recently published in Australia by the APRG.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, Australia is one of the few countries who have published guidelines. In the absence of a consensus view, the management of AVB still differs widely from country to country 5,9,10,31–33 …”

Section: Discussionmentioning

confidence: 99%

Implementation of evidence‐based management of acute bronchiolitis

Barben

2000

J Paediatrics Child Health

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Despite a lack of evidence for their efficacy and the recommendation of the Australian guidelines, pharmaceutical agents are frequently used in the management of AVB by paediatricians in Australia, although far less than reported in a recently published European survey. Guidelines alone are not sufficient to implement change and there is a need for more specific strategies to ensure that children receive appropriate management for this common condition.

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“…Whether bronchodilators should be used in the treatment of this disease has remained subject to discussion (1,2). Previous work has shown that bronchodilator responses in bronchiolitis range from marked improvement to deterioration of lung function (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

mentioning

confidence: 99%

Assessment of Bronchodilator Responsiveness in Infants with Bronchiolitis

Modl¹,

Eber²,

Weinhandl³

et al. 2000

Am J Respir Crit Care Med

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Whether bronchodilators should be used for the treatment of infants with bronchiolitis is subject to debate, partly because of the low sensitivity of the methods for assessing lung function changes in infants. In the present study, we compared the recently introduced raised volume (RVRTC) with the conventional end-tidal rapid thoracoabdominal compression (ETRTC) technique in infants with acute viral bronchiolitis. In 17 infants lung function was assessed by both methods, at baseline values and after salbutamol inhalation. Forced expiratory volumes (FEV(0.5), FEV(0.75), FEV(1.0)) were used for the quantification of RVRTC measurement, and maximal expiratory flow at functional residual capacity (Vmax (FRC)) for ETRTC measurements. A significant individual change was defined by a mean postbronchodilator value that differed from baseline value by more than twice the within-subject coefficient of variation (CV). Group mean intrasubject CVs ranged from 4.7% to 5.3% for FEV parameters; it was 14.0% for Vmax (FRC). For the group, post-bronchodilator measurements did not differ significantly from baseline measurements. For the majority of infants, however, the within-subject comparison of responses revealed substantial differences between both techniques; while no infant demonstrated a significant increase in Vmax (FRC), eight (47%) infants responded with significantly improved timed volumes. The RVRTC technique provides the investigator with a more sensitive diagnostic tool for documenting the effectiveness of therapeutic interventions on an individual basis. Furthermore, the findings of the present study provide a rationale for the application of bronchodilators in a subgroup of infants with acute bronchiolitis.

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Use of Adrenergic Bronchodilators by Pediatric Allergists and Pulmonologists

Cited by 15 publications

References 8 publications

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

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

Implementation of evidence‐based management of acute bronchiolitis

Assessment of Bronchodilator Responsiveness in Infants with Bronchiolitis

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