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Current management of acute bronchiolitis in Switzerland
1Division of Paediatric Pulmonary, Children's Hospital St Gallen. juerg.barben@gd-kispi.sg.ch
Insights
Most Swiss pediatricians use medications like bronchodilators and corticosteroids for infant bronchiolitis, despite limited evidence of effectiveness. This widespread use highlights a need for national guidelines to standardize treatment approaches.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Evidence-Based Medicine
Background:
- Acute bronchiolitis is a common infant respiratory infection.
- Current evidence suggests limited benefit from pharmaceutical interventions.
Purpose of the Study:
- To assess current treatment practices for acute bronchiolitis among Swiss pediatricians.
- To identify variations in the use of pharmaceutical agents.
Main Methods:
- A postal questionnaire survey was distributed to Swiss pediatricians.
- Response rate was 58% (541 out of 937).
Main Results:
- 78% of respondents treat acute bronchiolitis.
- Over 99% use bronchodilators and 41-57% use corticosteroids.
- Pediatric respiratory physicians used these agents less frequently than general pediatricians.
Conclusions:
- Significant variation exists in bronchiolitis treatment across Swiss pediatricians.
- Pharmaceutical agents are widely used despite a lack of supporting evidence.
- National guidelines are recommended to reduce treatment variability.
Introduction:
Acute bronchiolitis is the most common lower respiratory tract infection in the first year of life. Current expert opinion and scientific data suggest that pharmaceutical agents have little impact on the natural course of the disease.
Methods:
Postal questionnaires were sent to all Swiss paediatricians to assess their current practice for treating acute bronchiolitis in children.
Results:
Of a total of 937 questionnaires, 541 (58%) were returned. Of the respondents, 422 (78%) treat children with acute bronchiolitis. Up to 99% of paediatricians used bronchodilators in the outpatient and inpatient management, either routinely (up to 62%) or occasionally (37%). Steroids were used by 41% of the respondents in outpatient management and by 57% in inpatient management. The paediatric respiratory physicians tended to use bronchodilators and corticosteroids less frequently than the general paediatricians.
Conclusions:
A wide variation in the treatment of bronchiolitis was noted. Despite lack of evidence of benefit most Swiss paediatricians use pharmaceutical agents in the management of acute bronchiolitis. In particular, bronchodilators and corticosteroids were used in inpatient management in Switzerland much more frequently than recently reported for Australian paediatricians. National guidelines could be helpful in reducing the variations in the management of acute bronchiolitis in our country.
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