Additive effects of dexamethasone in nebulized salbutamol or l-epinephrine treated infants with acute bronchiolitis

BACKGROUND: Although it is the most common lower respiratory infection of infancy, the optimal treatment for acute bronchiolitis is still controversial. The aim of this study was to compare the early and late effects of nebulized L-epinephrine (EPI) and intramuscular dexamethasone (DEX) combination therapy with nebulized salbutamol (SAL) and dexamethasone combination and bronchodilators alone in outpatients with acute bronchiolitis. METHODS: A total of 69 infants aged 2-21 months who were admitted to the Pediatrics Department of the Faculty of Medicine, Mersin University, with acute bronchiolitis were included in a randomized, placebo-controlled, prospective trial study. Patients were assigned to receive either nebulized L-epinephrine (3 mg) or salbutamol (0.15 mg/kg) and 15 min later, either dexamethasone 0.6 mg/kg or placebo (PLA), intramuscularly, in a double-blind randomized fashion. The study groups were: epinephrine + dexamethasone group (group 1, n=23), salbutamol + dexamethasone group (group 2, n=23), epinephrine + placebo group (group 3, n=11), and salbutamol + placebo group (group 4, n=12). The outcome measures were heart rate, respiratory rate and Respiratory Distress Assessment Instrument (RDAI) score determined at 30, 60, 90 and 120 min, 24 h, and 5 days after the first therapy. Patients were then followed-up during the subsequent 2 months for the prevalance of respiratory complaints regarding bronchial hyperreactivity. RESULTS: There were no significant differences between the outcome variables of the four groups within the first 120 min and at 24 hours, or between the rates of requirement of a second dose of the same bronchodilator. However, fifth day RDAI score values of both DEX groups were significantly lower than that of SAL + PLA group (P=0.000 and P=0.01, respectively). The fifth day score value of group 1 was also significantly better than that value of EPI + PLA group but not different from group 2. CONCLUSIONS: A single dose of intramuscular dexamethasone added to nebulized L-epinephrine, or salbutamol therapies resulted in better outcome measures than bronchodilators alone in the late phase (fifth day) of mild to moderate degree bronchiolitis attack. However, effects of EPI + DEX combination was not different from SAL + DEX combination.     

Effect of oral and inhaled salbutamol in infants with bronchiolitis

The response of bronchiolitis to bronchodilator drugs is controversial. The present study was designed to evaluate the efficacy of oral or metered dose inhaler (MDI) salbutamol using a coffee cup as a spacer device in bronchiolitis. In the trial, 31 hospitalized patients between 6 and 24 months of age, who exhibited the first episode of acute bronchiolitis without any other predisposing illness such as cystic fibrosis, congenital heart disease etc., were randomly assigned to receive oral salbutamol (n=11, 0.1 mg/kg per dose, four times a day), or MDI salbutamol (n = 12, 200 μg per dose, every 3 h) or formed the control group without any bronchodilator therapy (n = 8). All of the patients were given supplemental oxygen as needed and adequate hydration was maintained. The patients were evaluated with clinical symptom scores. There were no differences in the beneficial or side effects of salbutamol, or the number of days in hospital between the treatment groups and the control group. It was concluded that there is no beneficial effect in using bronchodilators in infants with bronchiolitis. Supplemental oxygen and maintenance of normal hydration may be adequate.     

Nebulized hypertonic saline/salbutamol solution treatment in hospitalized children with mild to moderate bronchiolitis

Background: The objective of this study was to determine the efficacy and safety of nebulized 3% hypertonic saline solution and salbutamol in the treatment of mild to moderate bronchiolitis. Methods: In a randomized controlled trial, 93 infants with mild to moderate bronchiolitis were divided into two groups. The infants received inhalation of 2.5 mg (0.5 mL) salbutamol dissolved in either 4.0 mL normal (0.9%) saline (control group, n= 43) or 4.0 mL hypertonic (3%) saline (treatment group, n= 50). The therapy was repeated three times daily until discharge. Cough, wheezing, pulmonary physical signs, and the length of hospital stay were recorded. Results: Wheezing remission time was 3.8 ± 1.1 days in the control group and 2.7 ± 0.9 days in the treatment group (P < 0.01). Cough remission time was 6.3 ± 0.9 days in the control group and 5.3 ± 0.8 days in the treatment group (P < 0.01). The moist crackles disappeared at 5.4 ± 0.8 days in the treatment group versus 6.2 ± 0.9 days in the control group (P < 0.01). Furthermore, the average length of hospital stay decreased from 7.4 ± 1.5 days in the control group to 6.0 ± 1.2 days in the treatment group (P < 0.01). No obvious adverse effects were observed. Conclusions: Inhalation of nebulized 3% hypertonic saline solution and salbutamol is a safe and effective therapy for patients with mild to moderate bronchiolitis.     

The chest radiograph in acute bronchiolitis

The relationship between clinical severity, as judged by a clinical scoring method, and the degree of radiological change on a chest X-ray, was assessed in 153 children with acute bronchiolitis. There was no statistical correlation between clinical severity and the degree of radiological change. The majority of radiographs were requested on the assumption that it was a useful routine investigation. We suggest that the request for a chest X-ray in acute bronchiolitis should be made only when the need for intensive care is being considered, where there has been an unexpected deterioration in the child's condition or the child has an underlying cardiac or pulmonary disorder.     

Randomized controlled trial of nebulized adrenaline in acute bronchiolitis

Use of both l -epinephrine and racemic epinephrine (adrenaline) has improved clinical symptoms and composite respiratory scores in acute bronchiolitis. The objective of this randomized double-blind placebo-controlled study was to assess whether there was sufficient improvement in clinical state to reduce hospital admissions. Seventy-five infants aged 1 month to 1 year with a clinical diagnosis of acute bronchiolitis were treated with either 2 ml of 1:1000 nebulized adrenaline or 2 ml of nebulized normal saline administered after baseline assessment and 30 min later. Clinical respiratory parameters were recorded at 15-min intervals for a period of 2 h following the baseline assessment. Admission to hospital was the primary end-point and changes in respiratory parameters were secondary end-points. Fifty percent (19/38) of infants treated with adrenaline were discharged home compared with 38 percent (14/37) of those treated with saline. This 12 percent reduction in rate of admission is not statistically significant (95% CI of difference: −10% to 35%). There was no difference between treated and placebo groups in respiratory rate, oxygen saturation, heart rate or a composite respiratory distress score at 30, 60 or 120 min post-treatment. In this study, nebulized epinephrine did not confer a significant advantage over nebulized saline in the emergency room treatment of acute bronchiolitis.     

���Ը�Ⱦ��ϸ֧������

??Acute infectious bronchiolitis could be caused by virus??bacteria??fungus and Mycoplasma pneumoniae with non-specific histology in children. Fever??cough and wheeze were the clinical manifestations??while centrilobular nodules??tree-in-bud and bronchiolar wall thickening were the main HRCT findings. The short-term prognosis was often good??although long-term prognosis was not optimistic with asthma and recurrent wheezing left. Since acute Mycoplasma pneumoniae bronchiolitis cases seemed to increase recently??it should be paid attention to by pediatrician.     

Implementation of evidence-based management of acute bronchiolitis

OBJECTIVE: Implementation of clinical guidelines is frequently delayed well beyond their dissemination and the publication of clinical evidence. The recently published Australian guidelines for the management of acute viral bronchiolitis (AVB) have been evaluated by assessing the current practice of Australian paediatricians. METHODS: Questionnaire survey of all Australian paediatricians and a review of the literature. RESULTS: Of a total of 891 questionnaires, 555 (62%) were returned. Of the respondents, 373 (67%) treated children with AVB and, of these, 232 (67%) treated 10-50 children per year. A wide variation in management practice for both outpatient and inpatient treatment of AVB was identified. Up to 70% of paediatricians who treated AVB indicated using pharmaceutical agents in their outpatient management (88% in inpatient management), most using these agents 'sometimes' or in high-risk children. Paediatric respiratory physicians tended to use bronchodilators less frequently than general paediatricians. Compared with many countries in Europe, few Australian paediatricians routinely use supplementary drugs in the inpatient managenment of AVB; in particular, bronchodilators (61 vs 7%) and corticosteroids (11 vs 1%) are used far less often. A review of the literature demonstrated that pharmaceutical agents do not influence the course of AVB. CONCLUSIONS: Despite a lack of evidence for their efficacy and the recommendation of the Australian guidelines, pharmaceutical agents are frequently used in the management of AVB by paediatricians in Australia, although far less than reported in a recently published European survey. Guidelines alone are not sufficient to implement change and there is a need for more specific strategies to ensure that children receive appropriate management for this common condition.     

Gender analysis in acute bronchiolitis due to respiratory syncytial virus

It is reasonable to compare immune reactions between boys and girls because many infections in the early stages are predominant in males. A relationship between immunomodulatory effects of sex hormone surge in boys at early months and infectious diseases is still unclear. We compared clinical features between boys and girls who suffered from wheezing that was initially triggered by acute respiratory syncytial virus (RSV) bronchiolitis. For systemic immune response evaluation, white blood cell (WBC) count, blood eosinophil count, and serum C-reactive protein (CRP) were measured. For local inflammation evaluation, scores for eosinophils and neutrophils in sputum were evaluated microscopically. Patients consisted of 90 boys and 51 girls. Most children were under 6 months of age. WBC counts and serum CRP levels were significantly increased in girls compared with boys. Blood eosinophilia at the acute stage was rarely observed in children after 6 months of age. For local response evaluation, sputum specimens obtained from 42 boys and 29 girls were microscopically examined. Sputum eosinophil score of 2+ and more was observed in boys (6/42) exclusively. In contrast, sputum neutrophilia was commonly observed in boys and girls. From a follow-up study, we confirmed that 28 children with RSV bronchiolitis showed wheezing episodes afterwards. However, their blood and sputum eosinophilia during RSV bronchiolitis did not reflect their subsequent wheezing. We speculated that gender-specific responses to RSV infection might account for male susceptibility. Differences in RSV pathogenicity between boys and girls should be further investigated in terms of asthma progression.     

ADYNAMIA EPISODICA HEREDITARIA Treatment with Salbutamol

Abstract. Three sibs with adynamia episodica hereditaria are described. Treatment with salbutamol inhalation had a beneficial effect on the duration of their adynamic attacks. Continuous peroral treatment with salbutamol has been tried in these patients resulting in the almost complete prevention of attacks. No serious adverse effects have been recorded. Peroral treatment with salbutamol is recommended as the treatment of choice in young patients with adynamia episodica hereditaria and in patients with frequent attacks of adynamia.     

Serum immunoglobulin G subclasses and serum immunoglobulin A in acute bronchiolitis in infants

Serum IgG subclasses and Serum IgA were studied in 43 infants with acute bronchiolitis and 20 healthy infants. IgG subclasses were determined by a capture ELISA and IgA was quantified by turbidimetry. IgG1 concentrations were significantly lower in infants with bronchiolitis than in normal infants. The other IgG subclasses and IgA did not differ between the groups. The subgroups of infants with bronchiolitis who had previously suffered from otitis media or bronchitis, had significantly lower IgG2 than the other infants with bronchiolitis. The same was found for infants with bronchiolitis who had suffered from three or more lower respiratory tract infections. In infants who had suffered from upper or lower respiratory infections before the acute bronchiolitis, IgA was significantly higher than in infants without previous respiratory infections. Ten infants with bronchiolitis (23%) had IgGl deficiency, that is values below the lower reference limit calculated in a population of healthy Norwegian infants. No healthy infants had any IgGl deficiency. No infant with bronchiolitis had IgG2 or IgG3 deficiency. The low IgGl values found in infants with acute bronchiolitis, may be one cause for infants to be more susceptible to RS virus infections.     

Long and short-term effect of prednisolone in hospitalized infants with acute bronchiolitis

OBJECTIVE: To assess long and short-term effect of prednisolone in hospitalized infants with bronchiolitis. METHODOLOGY: A randomized and controlled trial was carried out at the Federal University of Rio Grande, Rio Grande-RS, Brazil. Twenty-eight patients were randomly allocated prednisolone (1 mg/kg/day for 5 days) plus standard care, and 24 patients allocated standard care alone. The primary endpoint was the prevalence of post-bronchiolitis wheezing at 1, 3, 6 and 12 months after hospital discharge. The secondary endpoints were: length of hospital stay, duration of oxygen therapy and time to clinical improvement during the hospitalization. RESULTS: There were no significant differences between the prednisolone and control group in the prevalence of post-bronchioltis wheezing at 1 month (73.1 vs 83.3%, P = 0.5), 3 months (73.1 vs 79.2%, P = 0.7), 6 months (65.4 vs 66.7%, P = 0.9) and 12 months (50.0 vs 58.3%, P = 0.5) after hospital discharge. No reduction was observed in the prednisolone group, compared with the control group, in terms of length of hospital stay (6.0 vs 5.0 days, P = 0.7), duration of oxygen therapy (24.0 vs 24.0 h, P = 0.4) and time to clinical resolution (4.0 vs 4.0 days, P = 0.8). CONCLUSIONS: Prednisolone has no significant effect on reducing the prevalence of post-bronchiolitis wheezing and on improving the acute course of illness in hospitalized infants with bronchiolitis.     

Human metapneumovirus in children with bronchiolitis or pneumonia in New Zealand

OBJECTIVES: To confirm the presence of human metapneumovirus (hMPV) in New Zealand and establish its prevalence in selected paediatric patient groups. METHODS: Nasopharyngeal swabs were collected in two separate paediatric studies enrolling children clinically diagnosed with either bronchiolitis or pneumonia and tested for hMPV by polymerase chain reaction. RESULTS: Nucleic acid detection tests demonstrated 5.3% of paediatric bronchiolitis cases were positive for hMPV RNA and 2.7% of children admitted with pneumonia tested positive for hMPV RNA. CONCLUSIONS: The presence of hMPV in New Zealand has been confirmed in two selected paediatric patient groups, namely children diagnosed with bronchiolitis and pneumonia. These results indicate that hMPV is associated with a minority of cases of bronchiolitis or pneumonia in this patient group.     

Acute viral bronchiolitis and its sequelae in developing countries

Acute viral bronchiolitis (AVB) is a common disease found throughout the world. Various aspects of it are being studied: its epidemiology, diagnosis, prognosis and treatment. Most of these studies are being conducted in developed countries, with only a few taking place in developing countries. Risk factors such as poor nutrition, an adverse environment and early weaning should be studied where these features are common. Treatment aspects such as cost-effectiveness in low income settings need further study. Use of ribavirin and respiratory syncytial virus (RSV)-immunoglobulin are good examples. Post-bronchiolitic sequelae also need to be studied in low income countries. There is evidence that bronchiolitis obliterans is unusually frequent in some Latin-American countries such as Argentina and Brazil. It will be helpful to undertake combined studies in countries with the same socio-economics, investigating the preventive and management aspects of AVB and its sequelae to reduce the morbidity and mortality.     

儿童感染后闭塞性细支气管炎研究进展

闭塞性细支气管炎(bronchiolitis obliterans,BO)是一种由严重小气道炎症损伤引起的少见的慢性气道阻塞性肺疾病。BO常见病因有感染、心肺或骨髓移植、吸入有毒物质、胃食管反流、结缔组织病及药物性等。儿童以感染后BO(post-infectious bronchiolitis obliterans,PIBO)最常见。文章综述PIBO研究进展。     

儿童肺炎支原体细支气管炎临床特点及预后研究

目的　探讨儿童肺炎支原体细支气管炎的临床特点及预后,提高对该病的认识。方法　对首都医科大学附属北京儿童医院呼吸二科病房2017年3月至2020年3月诊断的71例肺炎支原体细支气管炎患儿病例资料进行回顾性分析。结果　（1）71例患儿起病中位年龄6.6岁,均有咳嗽表现;97.2%（69/71）有发热,中位热峰39.4℃;36.6%（26/71）有喘息;39.4%（28/71）有低氧血症;81.7%（58/71）有过敏背景。（2）中位白细胞7.6×109/L,78.9%（56/71）C反应蛋白升高（15 mg/L）。仅40.8%（29/71）胸片提示网状结节影,71例肺部高分辨率CT（HRCT）均可见小叶中心结节、树芽征,35.2%（25/71）为弥漫性细支气管炎,38.0%（27/71）合并少量肺实变或者肺不张。8.5%（6/71）电子支气管镜检查可见广泛黏稠分泌物。（3）均予阿奇霉素治疗;98.6%（70/71）应用甲泼尼龙,单日最大量为1～6 mg/（kg·d）,首次应用时间中位病程为第10天,中位疗程为14 d。随访2.5～6.0个月,8.5%（6/71）发生闭塞性细支气管炎（BO）病情均为轻度;余91.5%（65/71）痊愈。（4）遗留BO患儿喘息、低氧血症、弥漫性细支气管炎的发生率明显高于未遗留BO者,P值分别为0.041、0.006和0.033。结论　肺炎支原体细支气管炎患儿多数有过敏背景。肺部HRCT表现为弥漫性病变,有喘息和低氧血症者,发生BO的可能性大。     

Risks of severity and readmission of Indigenous and non-Indigenous children hospitalised for bronchiolitis

Objective:   To describe the characteristics of children admitted to Royal Darwin Hospital with bronchiolitis, and to compare the severity of illness and incidence of subsequent readmission in Indigenous and non-Indigenous children.
Design, Setting and Participants:   Retrospective study of 101 children (aged ≤2 years) hospitalised with bronchiolitis to Royal Darwin Hospital between April 2005 and December 2006.
Main Outcome Measures:   Admission characteristics and indices of severity, treatment required (antibiotics etc.), reasons and incidence of readmissions (within 6 months).
Results:   Indigenous children had significantly more severe illness then non-Indigenous children ( n = 80 and 21, respectively), longer hospital stay (median = 6 and 3 days; P = 0.001) and oxygen requirement (median = 3 and 0; P = 0.004), pneumonia ( n = 14 and 0; P = 0.04) and antibiotics treatment (48 and 4; P = 0.001). The readmission rate for bronchiolitis was high (23%) with no significant difference between Indigenous and non-Indigenous children.
Conclusion:   Indigenous Australian children hospitalised with bronchiolitis have significantly more severe illness than non-Indigenous children. Points of intervention that can address this and the identified high readmission rate (within 6 months) are required.     

Effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis

Objective

To evaluate the effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis (AVB).

ϸ֧������Ӱ��ѧ����

??Bronchiolitis is the most common lower respiratory inflammation in infants younger than 5 years. Pathogens are variable, and the majority of bronchiolitis were caused by infection. The radiological presentations of bronchiolitis include direct signs ??bronchiol-ectasis??tree-bud??central lobular nodules?? and indirect signs??air trapping??Mosic sign??. Bronchiolitis caused by different entities will present different presentations. The combination of clinical information and radiological findings will provide evidence for correct diagnosis.