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PharmacoEconomics

, Volume 8, Issue 1, pp 9–13 | Cite as

Rational Prescribing for Acute Bronchiolitis

  • Ken Dawson
Leading Article Prescribing for Acute Bronchiolitis

Summary

Acute bronchiolitis is the commonest lower respiratory illness of infancy and early childhood, and it is usually associated with respiratory syncytial virus infection. In the majority of infants, the illness is self-limiting and hence management is directed at maintaining fluid intake, minimal handling and close observation. Children who develop apnoea, fatigue and/or feeding difficulties as well as progressive respiratory distress require hospital admission. Oxygen, intravenous fluids and minimal handling are the pillars of hospital management, and less than 1% of hospitalised infants require additional assisted ventilation.

Pharmacological therapy of acute bronchiolitis is contentious. Sympathomimetics are the drugs most frequently used. Inhaled salbutamol (atbuterol) has been associated with both positive and negative outcomes. Recent work suggests that nebulised racemic adrenaline (epinephrine) may be helpful in reducing respiratory distress, but further work is needed to confirm this finding.

The use of the antiviral drug ribavirin (tribavirin) in acute bronchiolitis remains very contentious. The overwhelming majority of infants do not require the drug and debate remains as to its true effectiveness. The literature tends to support its use in patients with underlying heart or lung disease, but the drug may not be cost effective in this setting. However. the costs of ribavirin therapy could be reduced by the implementation of more rigid treatment guidelines. A reduction in the use of bronchodilators. antibiotics and corticosteroids would help to reduce the overall costs of management.

To date, acute bronchiolitis has not lent itself to phamacological treatment and prescribing should therefore be very strictly audited by clinicians.

Keywords

Respiratory Syncytial Virus Salbutamol Bronchiolitis Respiratory Syncytial Virus Infection Ipratropium Bromide 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Nicolai T, Pohl A. Acute viral bronchiolitis in infancy: epidemiology and management. Lung 1990; 168 Suppl.: 396–405PubMedCrossRefGoogle Scholar
  2. 2.
    Wohl MEB, Chernick v. Bronchiolitis. Am Rev Resp Dis 1978; 118: 759–81PubMedGoogle Scholar
  3. 3.
    Everard ML, Milner AD. The respiratory syncytial virus and its role in acute bronchiolitis. Eur J Pediatr 1992; 151: 638–51PubMedCrossRefGoogle Scholar
  4. 4.
    Rakashi K, Cooriel IM. Management of bronchiolitis. Arch Dis Child 1994; 71: 463–9CrossRefGoogle Scholar
  5. 5.
    Tager IB, Weiss SB, Rosner B, et al. Effects of parental cigarette smoking On the pulmonary function of children. Am J Epidemiol 1979; 110: 15–26PubMedGoogle Scholar
  6. 6.
    Price JF. Acute and long-term effects of viral bronchiolitis in infancy. Lung 1990; 168: 414–21PubMedCrossRefGoogle Scholar
  7. 7.
    Webb MSC, Henry RL, Milner AD, et al. Continuing respiratory problems three and a half years after acute viral bronchiolitis. Arch Dis Child 1985; 60: 1064–7PubMedCrossRefGoogle Scholar
  8. 8.
    Dawson KP, Kennedy D, Asher I, et al. The management of acute bronchiolitis. J Paediatr Child Health 1993; 28: 335–7CrossRefGoogle Scholar
  9. 9.
    Wang EEL, Milner R, Allen U, et al. Bronchodilators for treatment of mild bronchiolitis: a factorial randomised trial. Arch Dis Child 1992; 67: 289–93PubMedCrossRefGoogle Scholar
  10. 10.
    Ho L, Collins G, Landau LI, et al. Effects of salbutamol on oxygen saturation in bronchiolitis. Arch Dis Child 1991; 66: 1061–4PubMedCrossRefGoogle Scholar
  11. 11.
    Prendiville A, Rose A, Maxwell DL, et al. Hypoxaeemia in wheezy infants after bronchodilator treatment. Arch Dis Child 1987; 62: 997–1000PubMedCrossRefGoogle Scholar
  12. 12.
    Klassen TP, Rowe PC, Sutcliffe T, et al. Randomized trial of salbutamol in acute bronchiolitis. J Pediatr 1991; 118: 807–11PubMedCrossRefGoogle Scholar
  13. 13.
    Kristjánsson S, Carlsen KCL, Wennergren G, et al. Nebulised racemic adrenaline in the treatment of acute bronchiolitis in infants and toddlers. Arch Dis Child 1993; 69: 650–4PubMedCrossRefGoogle Scholar
  14. 14.
    Ameratunga SN, Lennon DR, Asher MI, et al. Ribavirin therapy of respiratory syncytial virus infection. N Z Med J 1994; 107: 180–2PubMedGoogle Scholar
  15. 15.
    Smith DW, Frankel LR, Mathers LH, et al. A controlled trial of aerosolised ribavirin in infants receiving mechanical ventilation for severe respiratory syncytial virus infection. N Engl J Med 1991; 325: 24–9PubMedCrossRefGoogle Scholar
  16. 16.
    Jania HK, Stutman HR, Zaleska M, et al. Ribavirin effect on pulmonary function in young infants with respiratory syncytial virus bronchiolitis. Ped Infect Dis J 1993; 12: 214–8CrossRefGoogle Scholar
  17. 17.
    Lugo RA, Nahata MC. Pathogenesis and trealment of bronchiolitis. Clin Pharm 1993; 12: 95–116PubMedGoogle Scholar
  18. 18.
    Schuh S, Johnson D, Canny G, et al. Efficacy of adding nebulized ipratropium bromide to nebuliZed salbutamol therapy inacute bronchiolitis. Pediatrics 1992; 90: 920–3PubMedGoogle Scholar
  19. 19.
    Springer C, Bar-Yishay E, Uwayyed K, et al. Corticosteroids do not affect the clinical or physiological Status of infants with bronchiolitis. Ped Pulmonol 1990; 9: 181–5CrossRefGoogle Scholar
  20. 20.
    Nahata MC, Johnson JA, Powell DA. Management of bronchiolitis. Clin Pharm 1985; 4: 297–303PubMedGoogle Scholar
  21. 21.
    Dawson KP, Capaldi N. Prescribing patterns for acute bronchiolitis in a teaching hospital. Aust J Hosp Pharm 1993; 23: 249–51Google Scholar

Copyright information

© Adis International Limited 1995

Authors and Affiliations

  • Ken Dawson
    • 1
  1. 1.Faculty of Medicine and Health Sciences, UAE UniversityAl AinUnited Arab Emirates

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