In the Journals

Bronchiolitis research supports AAP guidelines on diagnosis, treatment

U.S. researchers reviewed data from multiple studies and offered several tips for identifying and caring for infants with bronchiolitis, including limiting the use of lab and radiographic tests and investigating alternative treatments to bronchodilators and corticosteroids, as recommended by the American Academy of Pediatrics.

“Multiple studies have documented variation in diagnostic testing, treatment, hospitalization rates and length of hospital stay for bronchiolitis, suggesting a lack of consensus and an opportunity to improve care for this common disorder,” wrote Joseph J. Zorc, MD, of the Children’s Hospital of Philadelphia, and Caroline B. Hall, MD, an Infectious Diseases in Children Editorial Board member from the University of Rochester School of Medicine and Dentistry, in a recently published article.

Bronchiolitis remains the leading cause of infant hospitalization in the United States, and data suggests that associated morbidity rates and cost have increased over recent decades.

Current research indicates that infants aged younger than 6 months with prematurity and underlying cardiopulmonary disease or immunodeficiency are at higher risk for severe bronchiolitis or death. Therefore identifying these risk factors is important for assessing disease progression, according to the researchers.

Pulse oximetry is another important measure of severity. In one study, a pulse oximetry level <94% was associated with more than a fivefold increase in the likelihood of hospitalization. Data from other studies indicated that lag time for oxygen saturation contributed to lengthier hospital stays.

After examining research about the efficacy of diagnostic tools, the researchers argued against the use of chest radiography. One study’s findings indicated that routine radiography did not improve diagnosis of bronchiolitis. Furthermore, clinicians who used radiographs often overprescribed antibiotics.

Data involving lab testing also showed that rapid viral antigen tests were not associated with improved bronchiolitis diagnoses. These tests appeared to have better sensitivity and specificity during peak viral season, according to the researchers, making them less effective outside of that particular period.

The reviewers also examined the results of bronchodilators and corticosteroids in the treatment of bronchiolitis. Recent research indicated no significant decreases in hospitalization rates or length of hospitalizations for either bronchodilators or corticosteroids. Other therapies, such as nebulized hypertonic saline, are still being evaluated.

New molecular diagnostic techniques showed respiratory syncytial virus (50% to 80% of cases), human metapneumovirus, parainfluenza viruses and influenza as major causes of bronchiolitis, with coinfection rates ranging from 10% to 30% in samples of hospitalized children.

The reviewers concluded that these research findings supported recommendations put forth by the AAP regarding diagnosis and management of bronchiolitis. However, they wrote that additional research is necessary “to explore the combination of these therapies and other interventions.”

Zorc JJ. Pediatrics. 2010;125:342-349.

U.S. researchers reviewed data from multiple studies and offered several tips for identifying and caring for infants with bronchiolitis, including limiting the use of lab and radiographic tests and investigating alternative treatments to bronchodilators and corticosteroids, as recommended by the American Academy of Pediatrics.

“Multiple studies have documented variation in diagnostic testing, treatment, hospitalization rates and length of hospital stay for bronchiolitis, suggesting a lack of consensus and an opportunity to improve care for this common disorder,” wrote Joseph J. Zorc, MD, of the Children’s Hospital of Philadelphia, and Caroline B. Hall, MD, an Infectious Diseases in Children Editorial Board member from the University of Rochester School of Medicine and Dentistry, in a recently published article.

Bronchiolitis remains the leading cause of infant hospitalization in the United States, and data suggests that associated morbidity rates and cost have increased over recent decades.

Current research indicates that infants aged younger than 6 months with prematurity and underlying cardiopulmonary disease or immunodeficiency are at higher risk for severe bronchiolitis or death. Therefore identifying these risk factors is important for assessing disease progression, according to the researchers.

Pulse oximetry is another important measure of severity. In one study, a pulse oximetry level <94% was associated with more than a fivefold increase in the likelihood of hospitalization. Data from other studies indicated that lag time for oxygen saturation contributed to lengthier hospital stays.

After examining research about the efficacy of diagnostic tools, the researchers argued against the use of chest radiography. One study’s findings indicated that routine radiography did not improve diagnosis of bronchiolitis. Furthermore, clinicians who used radiographs often overprescribed antibiotics.

Data involving lab testing also showed that rapid viral antigen tests were not associated with improved bronchiolitis diagnoses. These tests appeared to have better sensitivity and specificity during peak viral season, according to the researchers, making them less effective outside of that particular period.

The reviewers also examined the results of bronchodilators and corticosteroids in the treatment of bronchiolitis. Recent research indicated no significant decreases in hospitalization rates or length of hospitalizations for either bronchodilators or corticosteroids. Other therapies, such as nebulized hypertonic saline, are still being evaluated.

New molecular diagnostic techniques showed respiratory syncytial virus (50% to 80% of cases), human metapneumovirus, parainfluenza viruses and influenza as major causes of bronchiolitis, with coinfection rates ranging from 10% to 30% in samples of hospitalized children.

The reviewers concluded that these research findings supported recommendations put forth by the AAP regarding diagnosis and management of bronchiolitis. However, they wrote that additional research is necessary “to explore the combination of these therapies and other interventions.”

Zorc JJ. Pediatrics. 2010;125:342-349.