Bronquiolitis Cochrane

EVIDENCE-BASED CHILD HEALTH: A COCHRANE REVIEW JOURNAL
Evid.-Based Child Health 6: 258–275 (2011)
Published online in Wiley Online Library (onlinelibrary.wiley.com). DOI: 10.1002/ebch.673

Overview of Reviews
The Cochrane Library and the Treatment of Bronchiolitis
in Children: An Overview of Reviews
Liza Bialy,1 * Michelle Foisy,2 Michael Smith3 and Ricardo M. Fernandes4
1 AlbertaResearch Centre for Child Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
2 Cochrane Child Health Field, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
3 Department of Paediatrics, Craigavon Area Group Hospital Trust, Craigavon, Northern Ireland
4 Departamento da Crian¸a e da Fam´lia (Child and Family Department), Hospital deSanta Maria, Centro Hospitalar Lisboa Norte
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EPE, Lisboa,

Portugal

Background: Bronchiolitis describes a viral inflammation of the bronchioles in the lower respiratory tract
that is typically caused by infection with respiratory syncytial virus (RSV). Bronchiolitis is characterized by
high morbidity and affects approximately one in three infants. Children are currently treated with avariety of
therapies that may be ineffective or even harmful; potential therapies include antibiotics, bronchodilators, chest
physiotherapy, epinephrine, extrathoracic pressure, glucocorticoids, heliox, hypertonic saline, immunoglobulin,
inhaled corticosteroids and oxygen therapy.
Objectives: This updated overview of reviews aims to synthesize evidence from the Cochrane Database of SystematicReviews (CDSR) on the effectiveness and safety of 11 pharmacologic and non-pharmacologic treatments
to improve bronchiolitis symptoms in outpatient, inpatient and intensive care populations.
Methods: The CDSR was searched using the term ‘bronchiolitis’ restricted to the title, abstract or keywords
for all systematic reviews examining pharmacologic or non-pharmacologic interventions for thetreatment of
bronchiolitis in infants and children. Data were extracted, complied into tables, and synthesized using qualitative
and quantitative methods.
Main Results: For outpatients with bronchiolitis (defined as the first episode of wheezing in children under
two), nebulized epinephrine decreased hospitalization rate on day one by 33% (RR: 0.67; 95% CI: 0.50, 0.89;
4 trials; 920 participants).With the addition of glucocorticoids, there was a reduction of similar magnitude for
hospitalization rate within seven days (RR: 0.65; 95% CI: 0.44, 0.95; 1 trial; 400 participants). For inpatients,
nebulized epinephrine versus bronchodilator and 3% hypertonic saline versus 0.9% saline each decreased length
of stay: epinephrine decreased length of stay by seven hours (MD: −0.28; 95% CI: −0.46,−0.09; 4 trials;
261 participants), and 3% hypertonic saline decreased length of stay by 28 hours (MD: −1.16; 95% CI: −1.55,
−0.77; 4 trials; 282 participants).
Outpatients treated with epinephrine or epinephrine and glucocorticoid combined both had significantly lower
clinical scores at 60 minutes (SMD: −0.45; 95% CI: −0.66, −0.23; 4 trials; 900 participants, and SMD: −0.34;
95% CI: −0.54, −0.14;1 trial; 399 participants). For inpatients, epinephrine versus bronchodilator led to a
significantly lower clinical score at both 60 minutes (SMD: −0.79; 95% CI: −1.45, −0.13; 4 trials; 248 participants; I2 : 79%) and 120 minutes (SMD: −0.52; 95% CI: −0.86, −0.18; 1 trial; 140 participants). Inpatients
treated with chest physiotherapy or 3% hypertonic saline both had significantly lower clinicalscores at 1–3 days
(SMD: −0.55; 95% CI: −0.98, −0.12; 1 trial; 87 participants, and SMD: −0.84; 95% CI: −1.39, −0.30; 3
trials; 183 participants).
Authors’ Conclusions: For outpatients with bronchiolitis, nebulized epinephrine can be effective in avoiding
hospitalization. Systemic glucocorticoids such as dexamethasone cannot be recommended as a routine therapy
given the current level of...