Aggiornamento monografico
Gestione del bambino con bronchiolite: un approccio basato sull’evidenza
CASE MANAGEMENT OF BRONCHIOLITIS: AN EVIDENCE-BASED APPROACH
MARINA MACCHIAIOLO, ELISABETTA CASCIOLI, LUIGI VIOLA, PIERPAOLO MASTROIACOVO
Clinica Pediatrica, Università Cattolica del Sacro Cuore, Ro
Maggio 1999 - pagg. 291 -298
Abstract
The Authors discuss the major decision points in the case-management of bronchiolitis with
an evidence-based approach. On this basis, they recommend that criteria for admissions
should be restricted to at risk infants or infants with respiratory rate over 70 or difficult feeding;
diagnostic examinations should be limited to cases where etiology is dubious or complications
are possible, bronchodilators should not be used for their scarce efficacy or limited
to a trial dose; there is some evidence indicating that inhaled adrenaline is more efficacious
and should be preferred. Steroids should not be used and ribavirine has very limited
indications and precise requisites for effective use. Clinical and instrumental (SatO2) monitoring,
oxygen therapy when required, proper hydration and feeding remain the mainstems
of management of bronchiolitis.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
Current Opinion Pediatrics 10, 1-3, 1998.
2. Welliver R. Bronchiolitis and Infectious Asthma. In: Feign R, Cherry J (eds), Textbook of Pediatric Infectious Diseases. Philadelphia, United States of America, WB Saunders Company, 249-260, 1998.
3. Engel St, Newns GH: Proliferative mural bronchiolitis. Arch Dis Child 15, 219-229, 1940.
4. Shaw KN, Bell LM, Sherman NH: Outpatient assessment of infant with bronchiolitis. AJDC 145, 151-59, 1991.
5. Mulholland EK, Olinsky A, Shann FA: Clinical findings and severity of acute bronchiolitis. Lancet 335, 1259-61, 1990.
6. Rusconi F, Castagneto M, Sideri S, et al: La frequenza respiratoria: i valori normali. Medico e Bambino 5, 299-302, 1992.
7. Groothius JR, Gutierrez KM, Lauer BA: Respiratory syncytial virus infection in children with bronchopulmonary dysplasia. Pediatrics 82, 199-203, 1988.
8. Mcdonald NE, Hall CB, Suffin SC, et al: Respiratory syncytial virus infection in infants with congenital heart diseases. N Engl J Med 307, 397-400, 1982.
9. Navas L , Wang E. de Carvalho V, et al: Improved outcome of Respiratory syncytial virus infection in high risk hospidalized population of Canadian children. J Pedriatr 121, 348-54, 1992.
10. Kellner JD, Ohlsson A, Gadomsky AM, et al: Efficacy of bronchodilator therapy in bronchiolitis: a meta-analysis. Arch Ped Adol Med 150, 1166-72, 1996; pubblicata in versione aggiornata anche su Cochrane Library, 1998, issue 4.
11. Flores G, Horwitz RI: Efficacy of beta2- agonists in bronchiolitis: a reappraisal and meta-analysis. Pediatrics 100, 233-9, 1997.
12. Menon K, Sutcliffe T and Klassen TP: A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis. J Ped 126, 1004-7, 1995.
13. Dobson JV, Stephens-Groff SM, Mc- Mahon SR, et al: The use of albuterol in hospitalized infants with bronchiolitis. Pediatrics 101, 361-368, 1998.
14. Schweich P, Hurt T, Walkley E: The use of nebulized albuterol in wheezing infants. Pediatr Emerg Care 8, 184-188, 1992.
15. Ho L, Collis G, Landau LI, et al: Effect of salbutamol on oxygen saturation in bronchiolitis. Arch Dis Child 66, 1061-64, 1991.
16. Yaffe SE, Weiss CF, Cann HM et al: Should steroids be used in treating bronchiolitis? Pediatrics 46, 640-2, 1970.
17. Springer C, Bar-Yishay E, Uwayyed K, et al: Corticosteroids do not affect the clinical or physiological status of infants with bronchiolitis. Pediatr Pulmonology 9,181-185, 1990.
18. De Boeck K: Respiratory synctitial virus bronchiolitis. A double blind dexamethasone efficacy study. Am J Respir Crit Care Med 194 149, A345, 1994.
19. Roosevelt G, Sheehan K, Grupp-Phelan J, et al: Dexamethasone in bronchiolitis: a randomized controlled trial. Lancet 348, 292-59, 1996.
20. Van Woensel JBM, Wolfs TFW, van Aalderen WMC, et al: Randomized double blind placebo controlled trial of prednisolone in children admitted to hospital with respiratory syncitial virus bronchiolitis. Thorax 52, 634- 37, 1997.
21. Goodwin A: An uncontrolled assessment of nebulized budesonide in the treatment of acute bronchiolitis. Br J Clin Res 6, 113-9, 1995.
22. Reijonen T, Korppi M, Kuikka L, et al: Antiinflammatory therapy reduces wheezing after bronchiolitis. Arch Pediatr Adolesc Med 150, 512-7, 1996.
23. Richter H, Seddn P: Early nebulized budesonide in the treatment of bronchiolitis and the prevention of postbronchiolitic wheezing. J Pediatr 132, 849-53, 1998.
24. Berger I, Argaman Z, Schwartz SB, Segal E, et al: Efficacy of corticosteroidis in acute bronchiolitis: short-term and long-term follow- up. Pediatric Pulmonology 26, 162-166, 1998.
2. Welliver R. Bronchiolitis and Infectious Asthma. In: Feign R, Cherry J (eds), Textbook of Pediatric Infectious Diseases. Philadelphia, United States of America, WB Saunders Company, 249-260, 1998.
3. Engel St, Newns GH: Proliferative mural bronchiolitis. Arch Dis Child 15, 219-229, 1940.
4. Shaw KN, Bell LM, Sherman NH: Outpatient assessment of infant with bronchiolitis. AJDC 145, 151-59, 1991.
5. Mulholland EK, Olinsky A, Shann FA: Clinical findings and severity of acute bronchiolitis. Lancet 335, 1259-61, 1990.
6. Rusconi F, Castagneto M, Sideri S, et al: La frequenza respiratoria: i valori normali. Medico e Bambino 5, 299-302, 1992.
7. Groothius JR, Gutierrez KM, Lauer BA: Respiratory syncytial virus infection in children with bronchopulmonary dysplasia. Pediatrics 82, 199-203, 1988.
8. Mcdonald NE, Hall CB, Suffin SC, et al: Respiratory syncytial virus infection in infants with congenital heart diseases. N Engl J Med 307, 397-400, 1982.
9. Navas L , Wang E. de Carvalho V, et al: Improved outcome of Respiratory syncytial virus infection in high risk hospidalized population of Canadian children. J Pedriatr 121, 348-54, 1992.
10. Kellner JD, Ohlsson A, Gadomsky AM, et al: Efficacy of bronchodilator therapy in bronchiolitis: a meta-analysis. Arch Ped Adol Med 150, 1166-72, 1996; pubblicata in versione aggiornata anche su Cochrane Library, 1998, issue 4.
11. Flores G, Horwitz RI: Efficacy of beta2- agonists in bronchiolitis: a reappraisal and meta-analysis. Pediatrics 100, 233-9, 1997.
12. Menon K, Sutcliffe T and Klassen TP: A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis. J Ped 126, 1004-7, 1995.
13. Dobson JV, Stephens-Groff SM, Mc- Mahon SR, et al: The use of albuterol in hospitalized infants with bronchiolitis. Pediatrics 101, 361-368, 1998.
14. Schweich P, Hurt T, Walkley E: The use of nebulized albuterol in wheezing infants. Pediatr Emerg Care 8, 184-188, 1992.
15. Ho L, Collis G, Landau LI, et al: Effect of salbutamol on oxygen saturation in bronchiolitis. Arch Dis Child 66, 1061-64, 1991.
16. Yaffe SE, Weiss CF, Cann HM et al: Should steroids be used in treating bronchiolitis? Pediatrics 46, 640-2, 1970.
17. Springer C, Bar-Yishay E, Uwayyed K, et al: Corticosteroids do not affect the clinical or physiological status of infants with bronchiolitis. Pediatr Pulmonology 9,181-185, 1990.
18. De Boeck K: Respiratory synctitial virus bronchiolitis. A double blind dexamethasone efficacy study. Am J Respir Crit Care Med 194 149, A345, 1994.
19. Roosevelt G, Sheehan K, Grupp-Phelan J, et al: Dexamethasone in bronchiolitis: a randomized controlled trial. Lancet 348, 292-59, 1996.
20. Van Woensel JBM, Wolfs TFW, van Aalderen WMC, et al: Randomized double blind placebo controlled trial of prednisolone in children admitted to hospital with respiratory syncitial virus bronchiolitis. Thorax 52, 634- 37, 1997.
21. Goodwin A: An uncontrolled assessment of nebulized budesonide in the treatment of acute bronchiolitis. Br J Clin Res 6, 113-9, 1995.
22. Reijonen T, Korppi M, Kuikka L, et al: Antiinflammatory therapy reduces wheezing after bronchiolitis. Arch Pediatr Adolesc Med 150, 512-7, 1996.
23. Richter H, Seddn P: Early nebulized budesonide in the treatment of bronchiolitis and the prevention of postbronchiolitic wheezing. J Pediatr 132, 849-53, 1998.
24. Berger I, Argaman Z, Schwartz SB, Segal E, et al: Efficacy of corticosteroidis in acute bronchiolitis: short-term and long-term follow- up. Pediatric Pulmonology 26, 162-166, 1998.