SAN DIEGO – Key factors associated with the use of bronchodilators in young children hospitalized with bronchiolitis include older age and wheezing and hypoxia upon admission, results from a single-center study showed.
Although the American Academy of Pediatrics does not endorse the routine use of bronchodilators in the treatment of children hospitalized with bronchiolitis (Pediatrics 2006;118:1774-93), “there is substantial variability in the management of bronchiolitis, including the usage of bronchodilators,” researchers led by Dr. Janet Schairer wrote in an abstract presented at the annual meeting of the American Academy of Pediatrics. A recent Cochrane report showed that bronchodilators do not decrease length of hospitalization or reduce the time to illness resolution (Cochrane Database Syst. Rev. 2014; 6:CD001266).
Dr. Janet Schairer
In an effort to determine which demographic and clinical factors are associated with the use of bronchodilators in the treatment of children hospitalized with bronchiolitis, Dr. Schairer and her associates reviewed the medical records of 232 children aged 2 weeks to 24 months who were hospitalized with the condition at Jersey Shore University Medical Center, Neptune, N.J., from October 2009 until September 2012. Data analysis included multivariate regression models to identify variables that were associated with administration of bronchodilators.
Of the 232 children, 120 (51.7%) received bronchodilators and 112 (48.3%) did not. The researchers observed no difference in bronchodilator use among patients with risk factors for asthma, including family history of asthma, personal history of wheezing or eczema, and smoke exposure. “That surprised us,” Dr. Schairer of the division of general pediatrics at the medical center, said in an interview.
Compared with children who did not receive bronchodilators, those who did were older (a mean of 6.5 vs. 4.5 months, respectively; P less than .01); and at hospital admission had a higher prevalence of wheezing (45% vs. 19.6%; P less than .0001); diminished air exchange (10.8% vs. 2.7%; P less than .02), and hypoxia (38.3% vs. 25%; P less than .03). Other treatments administered to those who did and did not receive bronchodilators included nebulized 3% saline (37.9% vs. 36.5%), systemic steroids (10.9% vs. 0%), and antibiotics (45% vs. 33%).
Regression analysis revealed that the use of bronchodilators increased with older age (odds ratio, 0.89), and with oxygen requirement (OR, 1.15) or wheezing (OR, 1.23) at the time of admission. No association between bronchodilator use and length of hospitalization was observed (P > .05).
“Widespread implementation of the AAP guidelines for treatment of children with bronchiolitis is required for reduction of unnecessary use of bronchodilators in hospitalized patients,” Dr. Schairer and her associates concluded in the abstract. “Research to assess which, if any, demographic and clinical factors are associated with response to bronchodilator therapy is needed to further guide physicians in the treatment of bronchiolitis.”
She acknowledged certain limitations of the study, including its single-center design and relatively small cohort size.
Dr. Schairer reported having no financial disclosures.
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