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