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Conditions of vulnerability to the inadequate treatment of bronchiolitis
Kattia Cristina Neves1,2, Sandra Elisabete Vieira3,4
1. Mestre em Ciências pela Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil.
Insights
Non-recommended therapies like corticosteroids and antibiotics are frequently prescribed for infants with acute viral bronchiolitis, often without clear clinical justification. Bronchodilator use was indiscriminate, highlighting a need for improved treatment protocols.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Acute viral bronchiolitis is a common respiratory infection in infants.
- Current treatment guidelines often discourage the use of certain therapies, such as inhaled beta-agonists and corticosteroids.
- Variations in clinical practice regarding non-recommended therapies persist.
Purpose of the Study:
- To identify clinical and demographic factors associated with the prescription of non-recommended therapies for infants hospitalized with acute viral bronchiolitis.
- To analyze the patterns of use for inhaled beta-agonists, corticosteroids, antibiotics, and inhaled hypertonic saline solution.
Main Methods:
- A cross-sectional study involving 120 hospitalized infants diagnosed with respiratory syncytial virus (RSV) bronchiolitis.
- Exclusion criteria included infants with other infections or comorbidities.
- Data were retrospectively collected from medical records.
Main Results:
- High rates of non-recommended therapy use: 90% received inhaled beta-agonists, 72.5% corticosteroids, 40% antibiotics, and 66.7% inhaled hypertonic saline.
- Corticosteroid and antibiotic use correlated with indicators of severity (low oximetry, fever) and longer hospitalization, particularly in infants over 3 months old.
- Bronchodilator use showed no association with clinical variables, suggesting indiscriminate prescription.
Conclusions:
- Non-recommended therapies are frequently administered to infants with acute viral bronchiolitis.
- Prescription of corticosteroids and antibiotics, while linked to severity, was notably higher in infants over 3 months, indicating potential diagnostic uncertainty.
- Indiscriminate bronchodilator use and the association of inhaled hypertonic saline with longer hospital stays warrant further investigation and protocol development.
Objective:
To analyze clinical and demographic variables possibly associated with the prescriptions of non-recommended but routinely used therapies for infants with acute viral bronchiolitis.
Methods:
A cross-sectional study included hospitalized infants with bronchiolitis caused by the respiratory syncytial virus. Those with other associated infections and/or morbidities were excluded. The data were collected from medical records.
Results:
Among 120 cases, 90% used inhaled beta-agonists, 72.5% corticosteroids, 40% antibiotics, and 66.7% inhaled hypertonic saline solution. The use of bronchodilators did not present an independent association with another variable. More frequent use of corticosteroids was associated with low oximetry, longer hospitalization time, and age>3 months. Antibiotic therapy was associated with the presence of fever, longer hospitalization, and age>3 months. Inhaled hypertonic saline solution was associated with longer hospitalization time.
Conclusions:
Non-recommended prescriptions were frequent. Corticosteroid and antibiotic therapy were associated with signs of severity, as expected, but interestingly, they were more frequently used in infants above 3m, which suggested less safety in the diagnosis of viral bronchiolitis in these patients. The use of bronchodilators was even more worrying since they were indiscriminately used, without association with another variable related to the severity or characteristics of the host. The use of the inhaled hypertonic solution, although not associated with severity, seems to have implied a longer hospitalization time. The identification of these conditions of greater vulnerability to the prescription of inappropriate therapies contributes to the implantation of protocols for the bronchiolitis treatment, for continuing education and for analysis of the effectiveness of the strategies employed.
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