EVIDENCE-BASED CHILD HEALTH: A COCHRANE REVIEW JOURNAL Evid.-Based Child Health 9: 496–497 (2014) Published online in Wiley Online Library (http://www.evidence-basedchildhealth.com). DOI: 10.1002/ebch.1973
Eco-Paediatrics ...reducing waste in child health one intervention at a time.
Glucocorticoids for bronchiolitis—should they be used? Eco-paediatrics is an occasional feature in Evidence-Based Child Health: A Cochrane Review Journal. Our goal is to contribute to the worldwide discussion on reducing waste in health care. In each instalment, we will select a recent Cochrane review highlighting a practice, still in use, which the available evidence tells us should be discontinued.
Evidence-Based Child Health: a Cochrane Review Journal is now indexed by MEDLINE (http://www.ncbi. nlm.nih.gov/pubmed) and Scopus (http://www.scopus.com)
Experts from: Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson DW, Klassen TP, Hartling L. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004878. DOI: 10.1002/14651858.CD004878.pub4.
Evidence-Based Child Health, Editorial Office* *Correspondence to: Evidence-Based Child Health Canadian editorial office. E-mail: [email protected] Keywords: bronchiolitis, evidence-based medicine, corticosteroids
Reference
Bronchiolitis Bronchiolitis is an acute viral infection of the airways and lungs and is common in the first few years of life. The symptoms often begin with runny nose, mild fever and cough that lead to fast, troubled and often noisy breathing (wheezing).
1. Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118: 1774-1793. 10.1542/peds.2006-2223.
Commentary by E. Cohen
What do the guidelines suggest?
When I was a paediatric resident, I remember one of my attending physicians described the pharmacologic management of bronchiolitis in infants and children as ‘therapeutic nihilism’. There does not seem to be a consistently effective, acute medical treatment for this common and vexing problem. This review (1) supports the contention that steroid should not be routinely used in the treatment of this disease. Some questions remain as to whether there are sub-populations for which this treatment will be effective (e.g. the child with bronchiolitis who has asthma risk) (2), and whether combining steroids with epinephrine can be beneficial (3). However, even in those scenarios, the value of steroid therapy may be minimal. Unfortunately, in the absence of therapeutic alternatives for bronchiolitis, the use of steroid therapy will likely continue to exceed its benefit.
American Academy of Pediatrics (1)
Declaration of interest
Glucocorticoids Glucocorticoids (e.g. prednisolone or dexamethasone) are anti-inflammatory drugs that are used based on similarities between bronchiolitis and asthma.
What should we do in practice? Glucocorticoids do not reduce number of hospital admissions or the length of hospital stay for infants and young children with bronchiolitis. There is limited evidence on effectiveness of combined therapies and adverse effects of glucocorticoids.
Corticosteroid medications should not be used routinely in the management of bronchiolitis (recommendation: evidence level B; based on randomized controlled trial with limitations and a preponderance of risk over benefit).
Copyright © 2014 John Wiley & Sons, Ltd.
No conflict of interest to declare.
Eco-Paediatrics: Glucocorticoids for bronchiolitis—should they be used?
Eyal Cohen, EBCH Editor* Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada *Correspondence to: Eyal Cohen. E-mail: [email protected]
References 1. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiolitis
497
in infants and young children. Cochrane Database Syst Rev 2013;6:CD004878. 10.1002/14651858.CD004878.pub4. [Epub 5 June 2013]. 2. Alansari K, Sakran M, Davidson BL, Ibrahim K, Alrefai M, Zakaria I. Oral dexamethasone for bronchiolitis: a randomized trial. Pediatrics. 2013;132(4):e810-e816. 10.1542/peds.2012-3746. [Epub 18 September 2013]. 3. Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med . 2009;360(20):2079-2089. 10.1056/NEJMoa0900544. [Epub 15 May 2009].
If you would like to make a comment on the above article, you are invited to submit a letter to the Editor by email ([email protected]). Selected letters may be edited and published in future issues of the journal.
Copyright © 2014 John Wiley & Sons, Ltd.
Evid.-Based Child Health 9: 496–497 (2014) DOI: 10.1002/ebch.1973
Eco-Paediatrics ...reducing waste in child health one intervention at a time.
Glucocorticoids for bronchiolitis—should they be used? Eco-paediatrics is an occasional feature in Evidence-Based Child Health: A Cochrane Review Journal. Our goal is to contribute to the worldwide discussion on reducing waste in health care. In each instalment, we will select a recent Cochrane review highlighting a practice, still in use, which the available evidence tells us should be discontinued.
Evidence-Based Child Health: a Cochrane Review Journal is now indexed by MEDLINE (http://www.ncbi. nlm.nih.gov/pubmed) and Scopus (http://www.scopus.com)
Experts from: Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson DW, Klassen TP, Hartling L. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004878. DOI: 10.1002/14651858.CD004878.pub4.
Evidence-Based Child Health, Editorial Office* *Correspondence to: Evidence-Based Child Health Canadian editorial office. E-mail: [email protected] Keywords: bronchiolitis, evidence-based medicine, corticosteroids
Reference
Bronchiolitis Bronchiolitis is an acute viral infection of the airways and lungs and is common in the first few years of life. The symptoms often begin with runny nose, mild fever and cough that lead to fast, troubled and often noisy breathing (wheezing).
1. Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118: 1774-1793. 10.1542/peds.2006-2223.
Commentary by E. Cohen
What do the guidelines suggest?
When I was a paediatric resident, I remember one of my attending physicians described the pharmacologic management of bronchiolitis in infants and children as ‘therapeutic nihilism’. There does not seem to be a consistently effective, acute medical treatment for this common and vexing problem. This review (1) supports the contention that steroid should not be routinely used in the treatment of this disease. Some questions remain as to whether there are sub-populations for which this treatment will be effective (e.g. the child with bronchiolitis who has asthma risk) (2), and whether combining steroids with epinephrine can be beneficial (3). However, even in those scenarios, the value of steroid therapy may be minimal. Unfortunately, in the absence of therapeutic alternatives for bronchiolitis, the use of steroid therapy will likely continue to exceed its benefit.
American Academy of Pediatrics (1)
Declaration of interest
Glucocorticoids Glucocorticoids (e.g. prednisolone or dexamethasone) are anti-inflammatory drugs that are used based on similarities between bronchiolitis and asthma.
What should we do in practice? Glucocorticoids do not reduce number of hospital admissions or the length of hospital stay for infants and young children with bronchiolitis. There is limited evidence on effectiveness of combined therapies and adverse effects of glucocorticoids.
Corticosteroid medications should not be used routinely in the management of bronchiolitis (recommendation: evidence level B; based on randomized controlled trial with limitations and a preponderance of risk over benefit).
Copyright © 2014 John Wiley & Sons, Ltd.
No conflict of interest to declare.
Eco-Paediatrics: Glucocorticoids for bronchiolitis—should they be used?
Eyal Cohen, EBCH Editor* Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada *Correspondence to: Eyal Cohen. E-mail: [email protected]
References 1. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiolitis
497
in infants and young children. Cochrane Database Syst Rev 2013;6:CD004878. 10.1002/14651858.CD004878.pub4. [Epub 5 June 2013]. 2. Alansari K, Sakran M, Davidson BL, Ibrahim K, Alrefai M, Zakaria I. Oral dexamethasone for bronchiolitis: a randomized trial. Pediatrics. 2013;132(4):e810-e816. 10.1542/peds.2012-3746. [Epub 18 September 2013]. 3. Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med . 2009;360(20):2079-2089. 10.1056/NEJMoa0900544. [Epub 15 May 2009].
If you would like to make a comment on the above article, you are invited to submit a letter to the Editor by email ([email protected]). Selected letters may be edited and published in future issues of the journal.
Copyright © 2014 John Wiley & Sons, Ltd.
Evid.-Based Child Health 9: 496–497 (2014) DOI: 10.1002/ebch.1973
