Allergologia et Immunopathologia

Allergologia et Immunopathologia

Volume 42, Issue 4, July–August 2014, Pages 307-315
Allergologia et Immunopathologia

Original article
Overuse of bronchodilators and steroids in bronchiolitis of different severity: Bronchiolitis-study of variability, appropriateness, and adequacy

https://doi.org/10.1016/j.aller.2013.02.010Get rights and content

Abstract

Background

In the management of acute bronchiolitis there is a generalised use of treatments that have not been shown to be useful or efficacious in clinical studies. The objective of this study was to determine the appropriateness in the treatment of acute bronchiolitis of different severity within different clinical care settings.

Methods

This is a cross-sectional, descriptive study of 5647 cases of acute bronchiolitis in 91 Spanish hospitals and primary care centres. We classified the appropriateness of the treatments according to the recommendations of a consensus conference.

Results

There was an inappropriate use of treatments in 58.3% of the cases during the acute phase and in 45.4% during the maintenance phase. There was a generalised use of inhaled beta 2 agonists, regardless of the severity of the patients (hospitalised patients 69.3%, emergency care 63.2% and ambulatory 64.1%). Adrenaline was used in 30.1% of hospitalised cases and in 80.2% of intensive care patients. Systemic corticosteroids were not only used in one-third of hospitalised patients but also in 25.8% of ambulatory cases.

Conclusions

In acute bronchiolitis in Spain there is a wide use of treatments that are not recommended by the available clinical practice guidelines. Beta 2 agonist bronchodilators and corticosteroids are widely used and maintained, regardless of the severity of the patients.

Introduction

Acute bronchiolitis is the main cause of hospital admissions related to acute lower respiratory airway infections in infants. It has significant repercussions at all health care levels. Literature on the management of bronchiolitis is very abundant in diagnostic as well as preventive-therapeutic aspects. The published information has been revised in depth, and different clinical practice guidelines (CPGs) are available.1, 2, 3, 4, 5 The evidence suggests that in the treatment of bronchiolitis, the use of symptomatic support measures is fundamental for the management of fever, respiratory secretions, hyporexia, respiratory distress and hypoxaemia. Other treatments, in spite of their wide use, have not shown enough efficacy in clinical trials and present unfavourable benefit-risk ratios. A therapy trial with inhaled beta 2 agonists or adrenaline (better with hypertonic saline solution) has been proposed by some CPGs, but only for moderate-to-severe cases. These treatments can only be maintained if there is a documented improvement that compensates their costs and adverse effects.

The objective of our study was to analyse the appropriateness in the treatment of bronchiolitis in a large and representative sample of different health care settings in Spain. This study complements a preliminary one, conducted within the aBREVIADo Project, which describes the global variability in the clinical management. Here, we present an analysis of the appropriateness of the treatments in relation to the severity of the patients.6

Section snippets

Design

This was a cross-sectional, descriptive study of acute bronchiolitis cases in a sample of hospitals, emergency services and primary care centres or offices in Spain. The participating centres belonged to 12 autonomous communities (25 provinces) and corresponded to 31 hospital centres (18 complete hospitals, 7 hospitalisation services, and 6 emergency services) and 60 primary care centres or offices (Annex 1). The information of this descriptive study is part of the aBREVIADo Project

Results

Between October 2007 and March 2008, we gathered 5647 cases of bronchiolitis from 31 hospitals and 60 primary care centres/offices. The cases were predominantly diagnosed in the emergency departments (2914; 51.6%) and in hospitalisation wards (1576; 27.9%); 1060 (18.8%) were made in primary care offices, and 86 (1.5%) were made in the ICU. The health care setting was not specified in 11 cases.

Of the cases, 1874 (34.7%) children required hospitalisation. Because of the system used for gathering

Discussion

The characteristics of our study, including the number of cases (5647 infants younger than two years of age with a first episode of bronchiolitis from 91 sanitary centres and 25 provinces from 12 autonomous communities) and location of the study (bronchiolitis cared for at different health care settings: primary care consults, emergency department, hospitalisation, and ICU), allowed us to obtain representative data of the epidemiological characteristics and diagnostic-therapeutic management of

Protection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that no patient data appear in this article.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Funding

This project was financed by a grant from the Hospital de Torrevieja Foundation between June 2007 and June 2009 (protocol code: BECA0001).

Conflict of interest

No conflicts of interest to report.

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