Viral bronchiolitis in infants is an acute obstructive disease of small airways. Asthma, defined as recurrent episodes of lower respiratory tract obstruction, is frequently viral induced in young children. Differentiating between bronchiolitis and asthma is thus often difficult for clinicians. While the benefits of bronchodilators and anti-inflammatory agents are proven in asthma, they are controversial in the management of bronchiolitis. Recurrent episodes of lower airway obstruction should raise the suspicion of asthma and should be treated as such.The purpose of this study was to evaluate whether the current therapeutic practice of Quebec paediatricians differed when treating first-time or recurrent episodes of bronchiolitis.
Questionnaires were mailed to all members of the Quebec Paediatric Association in the fall of 2003, followed by a reminder 2 months later. Responses were collected through April 2004. Participants were specifically questioned on the type and frequency of treatment they used for the outpatient management of children with first-time and recurrent episodes of bronchiolitis.
A total of 550 questionnaires were sent, of which 330 (60%) were received within the deadline for analysis.
Despite the absence of clear indications, the majority of Quebec paediatricians use pharmacological agents such as inhaled β-agonists and corticosteroids to treat a first-time episode of bronchiolitis. On the other hand, there is a statistically significant (p≤0.001) and appropriate increase in their use of inhaled and systemic steroids, β-agonists and anti-leukotrienes when treating recurrent episodes of lower respiratory tract obstruction.
This study supports the need to develop and disseminate evidence-based recommendations for the treatment of infectious bronchiolitis in young children and underlines the appropriate use of anti-asthma medication for recurrent episodes of lower airway obstruction.
1st episodeRecurrent episodesalwayssometimesrarelyno answeralwayssometimesrarelyno answer%%%%%%%%anti-leukotriene119171025578ß-agonist4525246751456anticholinergic1389714869ß-adrenergic358111248113oral steroids8127641936405inhaled steroids19146346615154nasal drops (saline)66151546118165nasal decongestant1689428855physiotherapy715735919657
Denis Berubé, None.