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Anti-inflammatory therapy reduces wheezing after bronchiolitis
T Reijonen1, M Korppi, L Kuikka
1Department of Pediatrics, Kuopio (Finland) University Hospital.
Insights
Early anti-inflammatory therapy with nebulized cromolyn sodium or budesonide significantly reduced wheezing episodes and hospital admissions in infants after bronchiolitis. Children with atopy particularly benefited from these treatments.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Wheezing and recurrent respiratory symptoms are frequent sequelae of bronchiolitis.
- Early intervention may mitigate long-term respiratory issues.
Purpose of the Study:
- To investigate the efficacy of early anti-inflammatory therapy using nebulized cromolyn sodium or budesonide in reducing post-bronchiolitis wheezing.
- To assess the impact of these therapies on hospital admissions and symptomatic days.
Main Methods:
- A randomized controlled trial was conducted with 100 infants under 24 months with acute bronchiolitis.
- Participants were assigned to receive nebulized cromolyn sodium, budesonide, or no therapy (control) for 8 weeks.
- Outcomes included physician-diagnosed wheezing episodes, hospital admissions for bronchial obstruction, and parental-reported symptomatic days.
Main Results:
- Both cromolyn sodium and budesonide groups showed significantly fewer wheezing episodes compared to the control group during the second 8-week period.
- Budesonide therapy and treatment in children with atopy led to a significant reduction in hospital admissions.
- Children with atopy experienced more wheezing episodes and hospital admissions, highlighting their increased risk.
Conclusions:
- Nebulized cromolyn sodium and budesonide are effective in reducing wheezing and hospital admissions following bronchiolitis.
- Anti-inflammatory therapy is particularly beneficial for infants with atopy, who are at higher risk for recurrent respiratory symptoms.
- These findings support early anti-inflammatory treatment to improve outcomes after bronchiolitis.
Objective:
To evaluate whether early anti-inflammatory therapy with nebulized cromolyn sodium or budesonide reduces wheezing after bronchiolitis.
Design And Setting:
A randomized, controlled study in a university hospital that provides primary hospital care for all pediatric patients in a defined area.
Patients:
One hundred consecutive infants younger than 24 months treated in the hospital for acute bronchiolitis.
Interventions:
Thirty-four patients received cromolyn sodium, 20 mg four times a day for 8 weeks and 20 mg three times a day for 8 weeks, and 34 patients received budesonide, 500 micrograms twice a day for 8 weeks and 250 micrograms twice a day for 8 weeks, by a foot pump with a face mask; 32 patients in the control group received no therapy.
Main Outcome Measures:
Numbers of physician-diagnosed wheezing episodes, hospital admissions for bronchial obstructions, and symptomatic days recorded by the parents.
Results:
Children in the cromolyn sodium (19%) and budesonide (16%) groups had significantly fewer physician-diagnosed wheezing episodes than those in the control group (47%) during the second 8-week period (P < .05). A significant reduction in hospital admissions for bronchial obstructions was seen in the budesonide group and in the children with atopy in both treatment groups (P < .05). The children with atopy had significantly more subsequent wheezing episodes and hospital admissions than those without atopy (P < .05). The numbers of symptomatic days did not differ significantly among the three groups.
Conclusions:
Early anti-inflammatory therapy with nebulized cromolyn sodium or budesonide reduces the number of wheezing episodes and hospital admissions after bronchiolitis. Children with atopy are at high risk of subsequent wheezing episodes, and they particularly benefit from anti-inflammatory therapy.