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Pharmacologic treatment of bronchiolitis in infants and children: a systematic review
Valerie J King1, Meera Viswanathan, W Clayton Bordley
1Cecil B. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, Campus Box 7590, Chapel Hill, NC 27599-7595, USA.
Insights
This systematic review found little evidence supporting routine use of common drugs like bronchodilators and corticosteroids for infant bronchiolitis. More research is needed to determine effective treatment strategies for this common respiratory infection.
Area of Science:
- Pediatric respiratory infections
- Evidence-based medicine
- Clinical trial analysis
Background:
- Bronchiolitis is the leading cause of infant hospitalization for lower respiratory tract infections.
- Current treatment strategies, including bronchodilators and corticosteroids, lack consensus on optimal use.
- Understanding effective interventions is crucial for managing this common pediatric condition.
Purpose of the Study:
- To systematically review the efficacy of frequently used treatments for infant and childhood bronchiolitis.
- To synthesize evidence from randomized controlled trials on bronchiolitis interventions.
- To identify gaps in current research regarding bronchiolitis management.
Main Methods:
- Systematic literature search of MEDLINE and Cochrane Controlled Trials Register (1980-2002).
- Inclusion of randomized controlled trials (RCTs) with a minimum sample size of 10, published in English.
- Data abstraction and qualitative synthesis of interventions by drug category.
Main Results:
- Analysis of 54 RCTs, focusing on 44 studies of common interventions: epinephrine, beta2-agonist bronchodilators, corticosteroids, and ribavirin.
- Most included studies were underpowered to demonstrate statistically significant treatment effects.
- Limited data were available on clinically relevant outcomes such as hospitalization duration.
Conclusions:
- Current evidence provides minimal support for the routine use of common pharmacological interventions for bronchiolitis.
- A large, well-designed pragmatic trial is necessary to establish effective treatment strategies.
- Further research is essential to guide optimal clinical management of bronchiolitis.
Background:
Bronchiolitis is the most common lower respiratory tract infection in infants. Up to 3% of all children in their first year of life are hospitalized with bronchiolitis. Bronchodilators and corticosteroids are commonly used treatments, but little consensus exists about optimal management strategies.
Objective:
To conduct a systematic review of the effectiveness of commonly used treatments for bronchiolitis in infants and children.
Data Sources:
We searched MEDLINE and the Cochrane Controlled Trials Register for references to randomized controlled trials of bronchiolitis treatment published since 1980.
Study Selection:
Randomized controlled trials of interventions for bronchiolitis in infants and children were included if they were published in English between 1980 and November 2002 and had a minimum sample size of 10.
Data Extraction:
We abstracted data on characteristics of the study population, interventions used, and results of studies meeting entry criteria into evidence tables and analyzed them by drug category.
Data Synthesis:
Interventions were grouped by drug category and qualitatively synthesized.
Results:
Of 797 abstracts identified in the literature search, we included 54 randomized controlled trials. This review includes 44 studies of the most common interventions: epinephrine (n = 8), beta2-agonist bronchodilators (n = 13), corticosteroids (n = 13), and ribavirin (n = 10). Studies were, in general, underpowered to detect statistically significant outcome differences between study groups. Few studies collected data on outcomes that are of great importance to parents and clinicians, such as the need for and duration of hospitalization.
Conclusions:
Overall, little evidence supports a routine role for any of these drugs in treating patients with bronchiolitis. A sufficiently large, well-designed pragmatic trial of the commonly used interventions for bronchiolitis is needed to determine the most effective treatment strategies for managing this condition.
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