A new evidence report sponsored by the federal Agency for Healthcare Research and Quality says that although doctors commonly use a wide array of medications to treat bronchiolitis -- the most common lower-respiratory tract disease among infants and toddlers -- there is currently no compelling evidence to support these treatments.
Bronchiolitis is part of a family of diseases that affect airways in the lungs. It differs significantly from the more commonly diagnosed bronchitis, which can affect adults as well as children and is usually a complication of a viral infection, such as a cold or in influenza, or in chronic cases is found mostly in smokers. Bronchiolitis typically occurs in winter, starting in November and peaking in January or February. Common symptoms include runny nose, rapid or noisy breathing, wheezing, cough, fever, and irritability. The disease, which is usually caused by the respiratory syncytial virus, is especially rampant in day care centers and among hospitalized children.
Physicians often use medications such as inhaled, oral or intravenous corticosteroids, inhaled epinephrine and nebulized bronchiodilators to treat bronchiolitis because they are inexpensive and generally considered to be safe. But whether the medications actually work will not be known until they are studied in well-designed, adequately sized randomized clinical trials, according to the researchers, who also said that because of adverse events found in previous research, doctors should be cautious about using inhaled budesonide and alpha-2-interferon to treat bronchiolitis. The report was requested by the American Academy of Pediatrics and the American Academy of Family Physicians.
In addition, the researchers found no evidence that laboratory tests, complete blood counts or chest x-rays, which are sometimes used to diagnose bronchiolitis, are superior to a carefully conducted medical history and physical examination.
However, they did find evidence that supports the use of palivizumab as a preventative medicine, administered once a month intramuscularly, to protect high-risk infants and children who have underlying bronchopulmonary dysplasia -- a chronic lung disease -- or who were born prematurely and are under 6 months of age.
Although most cases of bronchiolitis are mild and short-term, severe cases account for 90,000 hospital admissions a year and 4,500 deaths, mostly among infants under 6 months of age. For the most part, seriously affected infants and young children have coexisting illnesses that increase the risk of complications.
A summary of the report, Management of Bronchiolitis in Infants and Children, which was prepared for AHRQ by the Research Triangle Institute-University of North Carolina Evidence-based Practice Center, can be found online at http://www.ahrq.gov/clinic/epcsums/broncsum.htm and also from the National Guideline Clearinghouse at www.guideline.gov (Select NGC Resources).
RSS