Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs?
<p>Abstract</p> <p>Background</p> <p>Bronchiolitis guidelines suggest that neither bronchodilators nor corticosteroids, antiviral and antibacterial agents should be routinely used. Although recommendations, many clinicians persistently prescribe drugs for bronchiolitis....
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2010-10-01
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| Series: | Italian Journal of Pediatrics |
| Online Access: | http://www.ijponline.net/content/36/1/67 |
| _version_ | 1818556437553479680 |
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| author | de Seta Federica Antonelli Fabio Pannuti Fortunato De Brasi Daniele Siani Paolo de Seta Luciano |
| author_facet | de Seta Federica Antonelli Fabio Pannuti Fortunato De Brasi Daniele Siani Paolo de Seta Luciano |
| author_sort | de Seta Federica |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Bronchiolitis guidelines suggest that neither bronchodilators nor corticosteroids, antiviral and antibacterial agents should be routinely used. Although recommendations, many clinicians persistently prescribe drugs for bronchiolitis.</p> <p>Aim of the study</p> <p>To unravel main reasons of pediatricians in prescribing drugs to infants with bronchiolitis, and to possibly correlate therapeutic choices to the severity of clinical presentation. Also possible influence of socially deprived condition on therapeutic choices is analyzed.</p> <p>Methods</p> <p>Patients admitted to Pediatric Division of 2 main Hospitals of Naples because of bronchiolitis in winter season 2008-2009 were prospectively analyzed. An RDAI (Respiratory Distress Assessment Instrument) score was assessed at different times from admission. Enrolment criteria were: age 1-12 months; 1<sup>st </sup>lower respiratory infection with cough and rhinitis with/without fever, wheezing, crackles, tachypnea, use of accessory muscles, and/or nasal flaring, low oxygen saturation, cyanosis. Social deprivation status was assessed by evaluating school graduation level of the origin area of the patients. A specific questionnaire was submitted to clinicians to unravel reasons of their therapeutic behavior.</p> <p>Results</p> <p>Eighty-four children were enrolled in the study. Mean age was 3.5 months. Forty-four per cent of patients presented with increased respiratory rate, 70.2% with chest retractions, and 7.1% with low SaO2. Mean starting RDAI score was 8. Lung consolidation was found in 3.5% on chest roentgenogram. Data analysis also unraveled that 64.2% matched clinical admission criteria. Social deprivation status analysis revealed that 72.6% of patients were from areas "at social risk". Evaluation of length of stay vs. social deprivation status evidenced no difference between "at social risk" and "not at social risk" patients. Following therapeutic interventions were prescribed: nasal suction (64.2%), oxygen administration (7.1%), antibiotics (50%), corticosteroids (85.7%), bronchodilators (91.6%). Statistically significant association was not found for any used drug with neither RDAI score nor social deprivation status. The reasons of hospital pediatricians to prescribe drugs were mainly the perception of clinical severity of the disease, the clinical findings at chest examination, and the detection of some improvement after drug administration.</p> <p>Conclusions</p> <p>We strongly confirm the large use of drugs in bronchiolitis management by hospital pediatricians. Main reason of this wrong practice appears to be the fact that pediatricians recognize bronchiolitis as a severe condition, with consequent anxiety in curing so acutely ill children without drugs, and that sometimes they feel forced to prescribe drugs because of personal reassurance or parental pressure. We also found that social "at risk" condition represents a main reason for hospitalization, not correlated to clinical severity of the disease neither to drug prescription. Eventually, we suggest a "step-by-step" strategy to rich a more evidence based approach to bronchiolitis therapy, by adopting specific and shared resident guidelines.</p> |
| first_indexed | 2024-12-13T23:47:20Z |
| format | Article |
| id | doaj.art-faa19344034c461281f83eee69c284b4 |
| institution | Directory Open Access Journal |
| issn | 1720-8424 1824-7288 |
| language | English |
| last_indexed | 2024-12-13T23:47:20Z |
| publishDate | 2010-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Italian Journal of Pediatrics |
| spelling | doaj.art-faa19344034c461281f83eee69c284b42022-12-21T23:26:55ZengBMCItalian Journal of Pediatrics1720-84241824-72882010-10-013616710.1186/1824-7288-36-67Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs?de Seta FedericaAntonelli FabioPannuti FortunatoDe Brasi DanieleSiani Paolode Seta Luciano<p>Abstract</p> <p>Background</p> <p>Bronchiolitis guidelines suggest that neither bronchodilators nor corticosteroids, antiviral and antibacterial agents should be routinely used. Although recommendations, many clinicians persistently prescribe drugs for bronchiolitis.</p> <p>Aim of the study</p> <p>To unravel main reasons of pediatricians in prescribing drugs to infants with bronchiolitis, and to possibly correlate therapeutic choices to the severity of clinical presentation. Also possible influence of socially deprived condition on therapeutic choices is analyzed.</p> <p>Methods</p> <p>Patients admitted to Pediatric Division of 2 main Hospitals of Naples because of bronchiolitis in winter season 2008-2009 were prospectively analyzed. An RDAI (Respiratory Distress Assessment Instrument) score was assessed at different times from admission. Enrolment criteria were: age 1-12 months; 1<sup>st </sup>lower respiratory infection with cough and rhinitis with/without fever, wheezing, crackles, tachypnea, use of accessory muscles, and/or nasal flaring, low oxygen saturation, cyanosis. Social deprivation status was assessed by evaluating school graduation level of the origin area of the patients. A specific questionnaire was submitted to clinicians to unravel reasons of their therapeutic behavior.</p> <p>Results</p> <p>Eighty-four children were enrolled in the study. Mean age was 3.5 months. Forty-four per cent of patients presented with increased respiratory rate, 70.2% with chest retractions, and 7.1% with low SaO2. Mean starting RDAI score was 8. Lung consolidation was found in 3.5% on chest roentgenogram. Data analysis also unraveled that 64.2% matched clinical admission criteria. Social deprivation status analysis revealed that 72.6% of patients were from areas "at social risk". Evaluation of length of stay vs. social deprivation status evidenced no difference between "at social risk" and "not at social risk" patients. Following therapeutic interventions were prescribed: nasal suction (64.2%), oxygen administration (7.1%), antibiotics (50%), corticosteroids (85.7%), bronchodilators (91.6%). Statistically significant association was not found for any used drug with neither RDAI score nor social deprivation status. The reasons of hospital pediatricians to prescribe drugs were mainly the perception of clinical severity of the disease, the clinical findings at chest examination, and the detection of some improvement after drug administration.</p> <p>Conclusions</p> <p>We strongly confirm the large use of drugs in bronchiolitis management by hospital pediatricians. Main reason of this wrong practice appears to be the fact that pediatricians recognize bronchiolitis as a severe condition, with consequent anxiety in curing so acutely ill children without drugs, and that sometimes they feel forced to prescribe drugs because of personal reassurance or parental pressure. We also found that social "at risk" condition represents a main reason for hospitalization, not correlated to clinical severity of the disease neither to drug prescription. Eventually, we suggest a "step-by-step" strategy to rich a more evidence based approach to bronchiolitis therapy, by adopting specific and shared resident guidelines.</p>http://www.ijponline.net/content/36/1/67 |
| spellingShingle | de Seta Federica Antonelli Fabio Pannuti Fortunato De Brasi Daniele Siani Paolo de Seta Luciano Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs? Italian Journal of Pediatrics |
| title | Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs? |
| title_full | Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs? |
| title_fullStr | Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs? |
| title_full_unstemmed | Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs? |
| title_short | Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs? |
| title_sort | therapeutic approach to bronchiolitis why pediatricians continue to overprescribe drugs |
| url | http://www.ijponline.net/content/36/1/67 |
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