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New AHRQ evidence reports are available on treatment of bronchiolitis in young infants and other topics

A new evidence report says that although doctors commonly use a wide array of medications to treat bronchiolitis—the most common lower-respiratory tract disease among infants and toddlers—there currently is no compelling evidence to support these treatments. The report was requested by the American Academy of Pediatrics and the American Academy of Family Physicians and prepared for the Agency for Healthcare Research and Quality by the Research Triangle Institute-University of North Carolina Evidence-based Practice Center (contract 290-97-0011).

Bronchiolitis is part of a family of diseases that affect airways in the lungs. It differs significantly from the more commonly diagnosed bronchitis, which can affect adults as well as children, and is usually a complication of a viral infection, such as a cold or influenza or in chronic cases is found mostly in smokers. Bronchiolitis typically occurs in winter, starting in November and peaking in January or February. Common symptoms include runny nose, rapid or noisy breathing, wheezing, cough, fever, and irritability. The disease, which is usually caused by the respiratory syncytial virus, is especially rampant in day care centers and among hospitalized children.

Physicians often use medications such as inhaled, oral, or intravenous corticosteroids, inhaled epinephrine, and nebulized bronchodilators to treat bronchiolitis because they are inexpensive and generally considered to be safe. But whether the medications actually work will not be known until they are studied in well-designed, adequately sized randomized clinical trials, according to the researchers, who also said that because of adverse events found in previous research, doctors should be cautious about using inhaled budesonide and alpha-2-interferon to treat bronchiolitis.

In addition, the researchers found no evidence that laboratory tests, complete blood counts, or chest x-rays—which are sometimes used to diagnose bronchiolitis—are superior to a carefully conducted medical history and physical examination. However, they did find evidence that supports the use of palivizumab as a preventive medicine, administered once a month intramuscularly, to protect high-risk infants and children who were born prematurely and are under 6 months of age or have underlying bronchopulmonary dysplasia, a chronic lung disease.

Although most cases of bronchiolitis are mild and short-term, severe cases account for 90,000 hospital admissions a year and 4,500 deaths, mostly among infants younger than 6 months of age. For the most part, seriously affected infants and young children have coexisting illnesses that increase the risk of complications.

Select to access the summary of the report Management of Bronchiolitis in Infants and Children, Evidence Report/Technology Assessment No. 69. The summary is also available online from the National Guideline Clearinghouse™.

Printed copies of the summary (AHRQ Publication No. 03-E009) are available from the AHRQ Publications Clearinghouse. The full report (AHRQ Publication No. 03-E014) is also available from the AHRQ Publications Clearinghouse.

Other evidence reports and summaries published recently by AHRQ include:

Editor's Note: All evidence reports and summaries are available online at the AHRQ Web site. Select for an index.

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