Controversie
Il trattamento farmacologico della bronchiolite
SHOULD BRONCHIOLITIS BE PHARMACOLOGICALLY TREATED? THE REASONS FOR NOT DOING IT
SHOULD BRONCHIOLITIS BE PHARMACOLOGICALLY TREATED? THE REASONS FOR DOING IT
EGIDIO BARBI1,GIOVANNI CAVAGNI2
1Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste,Dipartimento di Pediatria, Azienda Sanitaria di Modena
Aprile 2002 - pagg. 247 -251
Abstract
With regard to bronchiolitis, strong evidence of effectiveness does exist only for oxygen and
hydration. There is some evidence on the effectiveness of nebulised adrenaline, but it does not
significantly improve the clinical course, nor reduce the need for intensive care. There is no
sufficient evidence with respect to its possible use at home, also taking into account the uncertainties
on its safety profile.
The literature available on bronchiolitis shows that the effects of steroids, beta2-agonists and adrenaline are modest. However, there are patients who do respond to treatment and since we are not able to identify these patients, a treatment trial may be worthy. Recent evidence shows that effects of salbutamol and steroids may be synergic and that they are greater as the child gets older.
The literature available on bronchiolitis shows that the effects of steroids, beta2-agonists and adrenaline are modest. However, there are patients who do respond to treatment and since we are not able to identify these patients, a treatment trial may be worthy. Recent evidence shows that effects of salbutamol and steroids may be synergic and that they are greater as the child gets older.
Parole chiave
Classificazione MeSH
Bibliografia
1. Nelson WE. Textbook of Pediatrics, XVI
edition. Bronchiolits, pg 1182-4.
2. Berger I, Argamn Z, Schwartz S, et al. Efficacy of cortisteroids in acute bronchiolitis: short term and long term follow up. Pediatric Pulmonology 1998;26:162-6.
3. Cade A, Brownlee K, Conway S, et al. Randomized placebo controlled trial of nebulised corticosteroids in acute respiratory syncytial viral bronchiolitis. Arch Dis Child 2000; 82:126-30.
4. Cochrane Database Syst Rev. Bronchodilators for bronchiolitis 2000;(2):CD001266.
5. Lugo RA, Salyer JW, Dean JM. Albuterol in acute bronchiolitis-continued therapy despite poor response? Pharmacotherapy 1998 Jan-Feb;18(1):198-202.
6. Brand LP, Anja AP, Vaessen-Verberne. Differences in management of bronchiolitis between hospitals in the Netherlands. Eur J Pediatr 2000;159:343-7.
7. Offer I, Ashkenazi S, Livni G, Shalit I. The diagnostic and therapeutic approach to acute bronchiolitis in hospitalized children in Israel: a nation wide survey. Isr Med Assoc J 2000 Feb;2(2):108-10.
8. Garrison MM, Christakis DA, Harvey E, et al. Systemic corticosteroids in infant bronchiolitis: a meta-analysis. Pediatrics 2000 April;105(4):e44.
9. Reijonen T, Korppi M, Pitkakangas S, et al. The clinical efficacy of nebulized racemic epinephrine and albuterol in acute bronchiolitis. Arch Pediatr Adolesc Med 1995 June;Vol 149:686-92.
10. Sanchez J, De Koster J, Powell RE, et al. Effect of racemic epinephrine and salbutamol on clinical score and pulmonary mechanics in infants with bronchiolitis. J Pediatr 1993 Jan;122(1):145-51.
11. Menon K, Sutcliffe T, Klasse TP. A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis. J Pediatr 1995 Jun; 126(6):1004-7.
12. Kristiansson S, Lodrup KC, Wennergren G, et al. Nebulised racemic adrenaline in the treatment of acute bronchiolitis in infants and toddler. Arch Dis Child 1993;69:650-4.
13. Butte MJ, Nguyen BX, Hutchison TJ, et al. Pediatric myocardial infarction after racemic epinephrine administration. Pediatrics 1999 July;104(11):e9.
14. Rodriguez WJ, Arrobio J, Fink R, et al. Prospective follow up and pulmonary functions from a placebo controlled randomized trial of ribavirin therapy in respiratory syncityal virus bronchiolitis. Ribavirin Study- Group. Arch Pediatr Adolesc Med 1999 May;153(5):469-74.
15. American Academy of Pediatrics, Policy Statement. Reassessment of the indications for ribavirin therapy in respiratory syncytial virus infections. Pediatrics vol 97, No 1, Jan 1996:137-40.
16. Guerguerian AM, Gauthier M, Lebel MH, et al. Ribavirin in ventilated respiratory syncytial virus bronchiolitis. A randomized, placebo controlled trial. Am J Respir Crit Care Med 1999 Sept;160(3):829-34.
17. Law BJ, Wang EE, MacDonald N, et al. Does ribavirin impact on the hospital course of children with respiratory syncytial virus infection? An analysis using the pediatric investigators collaborative network on infections in Canada (PICNIC) RSV database. Pediatrics 1997 Mar;99(3):E7.
18. Valsecchi R, Galassini E, Marraro G, Luchetti M, Casiraghi G. Porcine-derived surfactant treatment of severe bronchiolitis. Acta Anaesthesiol Scand 1998 Aug;42(7):805- 10.
19. Wandstrat T. Respiratory syncytial virus immune globulin intravenous. Ann Pharmacother 1997 Jan;31(1):83-8.
20. Lenney W. Palivizumab and RSV prevention. Arch Dis Child 2000;83:87-8.
1. 1998-1999 Evidence based guidelines for the medical management of infants one year of age or less with a first time episode of bronchiolitis. Cincinnati (OH): Children’s Hospital Medical Center (CHMC),1998.
2. Garrison MM, Christakis DA, Harvey E, Cummings P, Davis RL. Systemic corticosteroids in infant bronchiolitis: A meta-analysis. Pediatrics 2000;105(4).
3. Kellner JD, Ohlsson A, Gadomski AM, Wang EE. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev, 2000.
4. Flores G, Horwitz. Efficacy of beta 2-agonists in bronchiolitis: a reappraisal and meta-analysis. Pediatrics 1997;100(2 Pt 1):233-9.
5. Menon K, et al. A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis. J Pediatr 1995;126(6):1004-7.
6. Canciani M. La bronchiolite oggi. In: Canciani M, Loroni L (eds). La Patologia delle basse vie respiratorie nell’infanzia. Athena 2001: 161.
2. Berger I, Argamn Z, Schwartz S, et al. Efficacy of cortisteroids in acute bronchiolitis: short term and long term follow up. Pediatric Pulmonology 1998;26:162-6.
3. Cade A, Brownlee K, Conway S, et al. Randomized placebo controlled trial of nebulised corticosteroids in acute respiratory syncytial viral bronchiolitis. Arch Dis Child 2000; 82:126-30.
4. Cochrane Database Syst Rev. Bronchodilators for bronchiolitis 2000;(2):CD001266.
5. Lugo RA, Salyer JW, Dean JM. Albuterol in acute bronchiolitis-continued therapy despite poor response? Pharmacotherapy 1998 Jan-Feb;18(1):198-202.
6. Brand LP, Anja AP, Vaessen-Verberne. Differences in management of bronchiolitis between hospitals in the Netherlands. Eur J Pediatr 2000;159:343-7.
7. Offer I, Ashkenazi S, Livni G, Shalit I. The diagnostic and therapeutic approach to acute bronchiolitis in hospitalized children in Israel: a nation wide survey. Isr Med Assoc J 2000 Feb;2(2):108-10.
8. Garrison MM, Christakis DA, Harvey E, et al. Systemic corticosteroids in infant bronchiolitis: a meta-analysis. Pediatrics 2000 April;105(4):e44.
9. Reijonen T, Korppi M, Pitkakangas S, et al. The clinical efficacy of nebulized racemic epinephrine and albuterol in acute bronchiolitis. Arch Pediatr Adolesc Med 1995 June;Vol 149:686-92.
10. Sanchez J, De Koster J, Powell RE, et al. Effect of racemic epinephrine and salbutamol on clinical score and pulmonary mechanics in infants with bronchiolitis. J Pediatr 1993 Jan;122(1):145-51.
11. Menon K, Sutcliffe T, Klasse TP. A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis. J Pediatr 1995 Jun; 126(6):1004-7.
12. Kristiansson S, Lodrup KC, Wennergren G, et al. Nebulised racemic adrenaline in the treatment of acute bronchiolitis in infants and toddler. Arch Dis Child 1993;69:650-4.
13. Butte MJ, Nguyen BX, Hutchison TJ, et al. Pediatric myocardial infarction after racemic epinephrine administration. Pediatrics 1999 July;104(11):e9.
14. Rodriguez WJ, Arrobio J, Fink R, et al. Prospective follow up and pulmonary functions from a placebo controlled randomized trial of ribavirin therapy in respiratory syncityal virus bronchiolitis. Ribavirin Study- Group. Arch Pediatr Adolesc Med 1999 May;153(5):469-74.
15. American Academy of Pediatrics, Policy Statement. Reassessment of the indications for ribavirin therapy in respiratory syncytial virus infections. Pediatrics vol 97, No 1, Jan 1996:137-40.
16. Guerguerian AM, Gauthier M, Lebel MH, et al. Ribavirin in ventilated respiratory syncytial virus bronchiolitis. A randomized, placebo controlled trial. Am J Respir Crit Care Med 1999 Sept;160(3):829-34.
17. Law BJ, Wang EE, MacDonald N, et al. Does ribavirin impact on the hospital course of children with respiratory syncytial virus infection? An analysis using the pediatric investigators collaborative network on infections in Canada (PICNIC) RSV database. Pediatrics 1997 Mar;99(3):E7.
18. Valsecchi R, Galassini E, Marraro G, Luchetti M, Casiraghi G. Porcine-derived surfactant treatment of severe bronchiolitis. Acta Anaesthesiol Scand 1998 Aug;42(7):805- 10.
19. Wandstrat T. Respiratory syncytial virus immune globulin intravenous. Ann Pharmacother 1997 Jan;31(1):83-8.
20. Lenney W. Palivizumab and RSV prevention. Arch Dis Child 2000;83:87-8.
1. 1998-1999 Evidence based guidelines for the medical management of infants one year of age or less with a first time episode of bronchiolitis. Cincinnati (OH): Children’s Hospital Medical Center (CHMC),1998.
2. Garrison MM, Christakis DA, Harvey E, Cummings P, Davis RL. Systemic corticosteroids in infant bronchiolitis: A meta-analysis. Pediatrics 2000;105(4).
3. Kellner JD, Ohlsson A, Gadomski AM, Wang EE. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev, 2000.
4. Flores G, Horwitz. Efficacy of beta 2-agonists in bronchiolitis: a reappraisal and meta-analysis. Pediatrics 1997;100(2 Pt 1):233-9.
5. Menon K, et al. A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis. J Pediatr 1995;126(6):1004-7.
6. Canciani M. La bronchiolite oggi. In: Canciani M, Loroni L (eds). La Patologia delle basse vie respiratorie nell’infanzia. Athena 2001: 161.