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Bronchodilator and steroid use for the management of bronchiolitis in Canadian pediatric emergency departments

  • Amy C. Plint (a1), Renee Grenon (a2), Terry P. Klassen (a3) and David W. Johnson (a4)

Abstract

Objective

Given the recent publication of several large trials and systematic reviews, we undertook a study of the current management of bronchiolitis in Canadian pediatric emergency departments (EDs) and explored physicians’ rationale for their treatment decisions. The overarching purpose of this study was to assist in planning a future trial of combined epinephrine and dexamethasone for bronchiolitis.

Methods

Physicians in the Pediatric Emergency Research Canada (PERC) database received an 18-item electronic survey. A modified Dillman method was used.

Results

Of the 271 physicians surveyed, 191 (70.1%) responded. The majority (120 of 271; 66.5%) reported ‘‘typically’’ giving a bronchodilator trial in the ED, with respondents almost evenly divided between treatment with salbutamol (n=62) and treatment with epinephrine (n=61). Of those who use salbutamol, 77.4% indicated that they prefer it because it can be prescribed for home use. Of those who use epinephrine, 80.3% indicated that they believe the medical literature supports its benefit over salbutamol. Few participants (2.6%) reported ‘‘always’’ using steroids, whereas the majority (62.8%) reported ‘‘sometimes’’ using them. The most common factor reported to influence steroid use was illness severity (73.3%). The majority (60.5%) reported that if corticosteroids were beneficial in bronchiolitis, they prefered treatment with a single dose in the ED as opposed to a multiday course.

Conclusions

Our results indicate that physicians practicing in Canadian pediatric EDs commonly use bronchodilators to manage bronchiolitis but use corticosteroids less commonly. They appear to be uncomfortable using corticosteroids, particularly longer courses, and have a stated preference for a single dose. Any future trial examining the role of corticosteroids in bronchiolitis should carefully consider the issue of steroid dosage.

Objectifs

Devant la publication récente de résultats de plusieurs essais de grande taille et revues systématiques, nous avons décidé de mener une étude sur le traitement de la bronchiolite dans les services des urgences (SU) pédiatriques, au Canada, et d’examiner les arguments mis de l’avant par les médecins pour justifier leurs décisions relatives au traitement. L’étude avait pour but premier de faciliter la planification d’un essai futur associant l’épiné phrine et la dexaméthasone dans le traitement de la bronchiolite.

Méthode

Une enquête électronique, comptant 18 éléments, a d’abord été versée dans la base de données du Groupe de Recherche en Urgence Pédiatrique du Canada, après quoi nous avons appliqué une version modifiée de la méthode de Dillman.

Résultats

Deux cent soixante et onze médecins ont reçu le questionnaire; sur ce nombre, 191 (70.1%) y ont répondu. Une majorité (120 sur 271; 66.5%) de répondants a indiqué qu’ils faisaient «généralement» l’essai d’un bronchodilatateur au SU, essai réparti presque également entre le salbutamol (n=62) et l’épinéphrine (n=61). Parmi ceux qui utilisaient le salbutamol, 77.4% ont indiqué qu’ils préféraient ce médicament parce qu’il pouvait s’utiliser à domicile; quant à ceux qui utilisaient l’épinéphrine, 80.3% ont indiqué qu’à leur avis la documentation médicale plaidait en sa faveur. Un très faible pourcentage de participants (2.6%) a indiqué «toujours» utiliser des stéroïdes, tandis que la majorité (62.8%) a indiqué en faire «parfois» usage. Le facteur le plus souvent (73.3%) invoqué pour justifier le recours aux stéroïdes était la gravité de la maladie. Enfin, une majorité (60.5%) de répondants a indiqué que, si les corticosté roides avaient un effet bénéfique dans le traitement de la bronchiolite, ils préféraient en administrer une seule dose au SU plutôt que de prescrire un traitement prolongé sur plusieurs jours.

Conclusions

D’après les résultats de l’enquê te, les médecins qui travaillent dans les SU pédiatriques, au Canada, utilisent souvent des bronchodilatateurs pour traiter la bronchiolite et moins souvent des corticostéroïdes. IIs semblent mal à l’aise devant le recours aux corticostéroïdes, notamment devant leur emploi prolongé , et ils ont une nette préférence pour les doses uniques. La question de la posologie des stéroïdes devrait donc être soigneusement examinée dans tout essai futur portant sur le rôle des corticostéroïdes dans la bronchiolite.

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Copyright

Corresponding author

Correspondence to: Dr. Amy C. Plint, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1; plint@cheo.on.ca.

References

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