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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Recent evidence on the management of bronchiolitis
Alan R Schroeder1, Jonathan M Mansbach
1aDepartment of Pediatrics, Santa Clara Valley Medical Center, San Jose, California bDepartment of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Bronchiolitis treatments and diagnostic tests offer limited benefits for infants. Future efforts should prioritize reducing unnecessary interventions and identifying specific patient groups for targeted therapies.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Bronchiolitis is a frequent pediatric illness and a primary reason for infant hospitalizations.
- Current diagnostic and therapeutic approaches for bronchiolitis show significant variability.
- Existing pharmacologic treatments have not demonstrated clear benefits or improved patient outcomes.
Purpose of the Study:
- To review the current landscape of bronchiolitis diagnosis and treatment.
- To evaluate the efficacy of commonly used therapies and diagnostic strategies.
- To identify areas for future research and quality improvement in bronchiolitis care.
Main Methods:
- Literature review of recent studies on bronchiolitis.
- Analysis of evidence regarding the effectiveness of various treatments (e.g., beta-agonists, corticosteroids, epinephrine, hypertonic saline).
- Examination of advances in understanding the viral epidemiology of bronchiolitis.
Main Results:
- Beta-agonist use persists despite evidence of no reduction in hospital admissions or length of stay.
- Many initially promising therapies, including corticosteroids, nebulized racemic epinephrine, and hypertonic saline, have proven ineffective.
- Recent research has enhanced understanding of viral causes and coinfections in bronchiolitis, but clinical impact remains uncertain.
Conclusions:
- Past research has heavily focused on developing new therapies for bronchiolitis.
- Future quality improvement should emphasize limiting unnecessary testing and treatments.
- Further research is needed to identify subgroups of children who might benefit from specific interventions.
Purpose Of Review:
Bronchiolitis is a common condition in children less than 2 years of age and is a leading cause of infant hospitalization. Although there is significant variability in testing and treatment of children with bronchiolitis, diagnostic testing rarely improves care, and no currently available pharmacologic options have been proven to provide meaningful benefits or improve outcomes.
Recent Findings:
Beta-agonists continue to be used frequently despite evidence that they do not reduce hospital admissions or length of stay. In general, therapies initially considered promising were subsequently proven ineffective, a pattern seen in studies on corticosteroids, and more recently with nebulized racemic epinephrine and hypertonic saline. Recent research has improved our understanding of the viral epidemiology of bronchiolitis, with increasing recognition of viruses other than respiratory syncytial virus and better awareness of the role of viral coinfections. How these findings will translate into improved outcomes remains uncertain.
Summary:
Much of the emphasis of the last few decades of bronchiolitis clinical care and research has centered on the identification and testing of novel therapies. Future quality improvement efforts should focus more on the limitation of unnecessary testing and treatments. Future research should include identification of subgroups of children with bronchiolitis that may benefit from focused clinical interventions.
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