Bronchiolitis is a common and highly contagious lung infection that affects children under the age of two, in the fall and especially in the winter. Due to a virus that causes obstruction of the bronchioles, the small airways of the lungs, it is characterized by inflammation of the latter. It is a leading cause of hospitalization for babies and is usually treated with Albuterol (also known as Salbutamol), administered by inhaler. This is despite numerous data showing no benefit in most patients and many potential side effects. Also, researchers are now trying to reduce its use. Today, a new study published in the journal Pediatrics redefines standard hospital treatment for this infection and lowers albuterol without compromising quality of care.
In 2014, theAmerican Academy of Pediatrics (AAP) changed its guidelines on bronchiolitis, recommending not to use bronchodilators (drugs often used in the form of aerosols to increase air passage by relaxing the bronchial muscle) like Albuterol in patients with typical bronchiolitis, symptoms of a viral infection of the upper respiratory tract that progresses to the lower respiratory tract. In order to align with these recommendations, researchers from the Children’s Hospital of Philadelphia (CHOP) used a multidisciplinary approach. “We are in the process of revising our treatment plan, or clinical pathway, to reflect current PAA guidelines and to educate clinicians on the recommended changes,” said Michelle Dunn, treating physician in general pediatrics at CHOP and lead author of the study.
She and her colleagues therefore changed the treatment plans for the emergency department and inpatients. In detail, they sensitized nurses, respiratory therapists and doctors to the new guidelines and modified the electronic health record system by creating a “do not order” option, indicating that bronchodilators were not recommended for a current use. The study took place from October 2014 to March 2017.
“Focus on using the high-flow nasal cannula”
In the end, the use of albuterol in infants with bronchiolitis increased from 43% to 20% in the emergency department and from 18% to 11% in hospital care facilities. As a result, 600 infants did not receive unnecessary treatment. Best of all: by measuring patient admissions rates, length of stay, and revisit rates, the researchers found that reducing Albuterol made no difference.
“The methods used in this study can be applied to other diagnoses where there is a potential overuse of tests and interventions”, welcomes Joseph J. Zorc, attending physician in emergency medicine at CHOP and lead author of the ‘study. Now, “the next step to improving bronchiolitis care at CHOP is to focus on the use of the high-flow nasal cannula, an emerging therapy for infants with severe bronchiolitis”.
France currently affected by an epidemic of bronchiolitis
In France, concerning the use of bronchodilators in infants suffering from bronchiolitis, the High Health Authority noted in November 2019 : “It is not recommended to administer beta-2mimetics (Salbutamol, Terbutaline) in the management of BA due to the lack of sufficient data on responder profiles. Administration may be poorly tolerated in infants less than 2 months of age. ” Furthermore, “it is not recommended to administer a combination of hypertonic saline and Salbutamol in the management of acute bronchiolitis in the absence of sufficient data.”
Currently, the country faces a bronchiolitis epidemic. In the first week of January, 5,024 children under the age of 2 were taken to the emergency room. Among them, 4,454 (89%) were less than a year old. In detail, 1,759 children (35%) were hospitalized, of which 1,633 (93%) were less than one year old.
In 70% of cases, the disease is caused by a respiratory syncytial virus (or RSV). The rest of the time, adenovirus, parainfluenzae virus or rhinovirus are involved. A nasopharyngitis of the child or the adult can thus be to cause a bronchiolitis in an infant present in the entourage.
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